Is there a role for ultrasound in acute scrotal pain: A 3-year audit of acute scrotal pain presentations to a multi-campus tertiary hospital.

Introduction: It is accepted that scrotal exploration should be undertaken if testicular torsion is suspected. We set out to assess the incidence of torsion in patients undergoing scrotal exploration, and whether pre-operative ultrasound influenced the decision to operate. Method(s): We conducted a 3-year audit of emergency scrotal explorations for acute scrotal pain at the Monash Hospital network, (undertaken by paediatric surgery, urology and general surgery). Patient and hospital/surgical team demographics were collected, as well as information about duration of pain, time to proceeding to surgery, incidence of torsion, orchidopexy (uni/bilateral) and orchidectomy. We also assessed the numbers of patient who received preoperative ultrasound, the ultrasound results, and whether this correlated to clinical findings at the time of surgery. Result(s): There were 290 scrotal explorations, 106 confirmed torsions and 15 orchidectomies. Age range of presentation was 2 days to 56 years (mean 13.9). Duration of pain prior to presentation was 15 minutes to 5 weeks (mean 31 hours). Time from presentation to commencement of surgery was 39-2880 minutes (mean 203 minutes). Highest incidence of exploration occurred in 12-15 year olds. 45 patients underwent preoperative ultrasound; 25 suggested definitive torsion. Of these, 22 were confirmed at operation. Of remaining ultrasounds, most suggested alternative pathology but stated 'torsion cannot be excluded', and 3 suggested intermittent torsion. Of those equivocal reports, 1 of 18 patients was torted at operation. (Table Presented) Conclusion(s): Torsion was more common in adolescents as expected. Ultrasound may be useful in select cases of scrotal pain where there is low clinical suspicion of torsion, but does not replace clinical judgement, and should not delay prompt surgical exploration in suspected torsion.