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Philipps-Universität Marburg
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Abstract
Summary
The diagnosis acute scrotum comprises various different clinical syndromes
all of which are characterised by pain and swellings in the area
around the scrotum. Apart from diseases that need to be immediately operated
on, such as spermatic cord torsion, there are diseases that are
mainly treated conservatively (e.g. acute epididymitis). The major challenge
for clinicians is to decide, which is a surgical emergency and which
is not. Thus, the diagnosis has to be reached rather quickly since a completely
twisted testicle is irreversibly damaged after about six hours –
which may result in the loss of the organ. In other words, spermatic cord
torsion is an extreme emergency and is therefore of major clinical interest
with regard to the acute scrotum.
This thesis found that torsion of the spermatic cord caused the pain in
53% of the altogether 230 retrospectively reviewed patients who underwent
surgical exploration when diagnosed with an acute scrotum. On average
these patients were adolescents who were 15.5 years of age. Patients
were more likely to be diagnosed with spermatic cord torsion when
the symptoms had not lasted long. On average they were admitted to the
Universiy Hospital Marburg after six hours, which was significantly earlier
than patients suffering from torsion of the testis appendages, epiditymitis/
epididymorchitis or other causes (p < 0.001). When the clinical examination
revealed a high testicular position the probability of spermatic cord
torsion was also significantly higher (p < 0.001). Reddening and swelling
of the scrotum are less specific parameters; they could be found in nearly
all of the patients who were examined. The data show, however, that both
the medical history and the physical findings can yield important clues
about the aetiological evaluation of the acute scrotum. In contrast to some
authors this study did not find a seasonal increase of the acute scrotum or
an increase of spermatic cord torsion in cold outdoor temperatures respectively.
The doppler ultrasound scan of the testicle is vital to the aetological
evaluation of the acute scrotum. The examined data revealed that
most of the patients suffering from spermatic cord torsion were typically
found to have reduced or lacking arterial/venous blood flow. However, in
almost half of the cases no such characteristic could be found, which
clearly shows of what little use these findings are as far as emergencies
are concerned. Furthermore, this diagnostic technique very much depends
on the qualifications of the clinician, a factor not to be underestimated.
In conclusion, it has to be said that the diagnosis of the acute scrotum will
continue to face clinicians with a challenge. Despite widely available
technical possibilities such as (colour) doppler ultrasound parameters
such as medical history, physical findings and demographic data remain
of utmost importance for reaching a diagnosis. A single, reliable predicator
for spermatic cord torsion could not be found in this study.
Thus the clinical conclusion is: The only way to rule out spermatic cord
torsion beyond any doubt when there are no obvious clinical results is
immediate surgical exploration of the testicle – „Whenever doubt exists, it
is safer to explore“ (Thomas, 2008).
Review
Metadata
Contributors
Supervisor:
Dates
Created: 2014Issued: 2015-01-21
Faculty
Medizin
Publisher
Philipps-Universität Marburg
Language
ger
Data types
DoctoralThesis
Keywords
Akutes Skrotumspermatic cord torsionemergencyKlinische PrädiktorenNotfallacute scrotumHodentorsionclinical predictor
DFG-subjects
Hodenkrankheit
DDC-Numbers
610
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Wappelhorst, Dirk Georg (106690684X): Akutes Skrotum - Evaluierung der Ursachen nach operativer Therapie. : Philipps-Universität Marburg 2015-01-21. DOI: https://doi.org/10.17192/z2015.0013.
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This item has been published with the following license: In Copyright