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Observational Study
. 2022 May;104(5):373-379.
doi: 10.1308/rcsann.2021.0190. Epub 2021 Dec 23.

Comparing the surgical management of acute paediatric scrotal pain between adult urologists and general surgeons in the UK: an observational study

H N Bermingham  1 , M A Popplewell  1 , D N Naumann  1 , M A Gulamhussein  1 , F Liaw  2 , G R Layton  1 , H Fernando  2 , O Tucker  1 , D Bowley  1 , M P Dilworth  1
Affiliations
Observational Study

Comparing the surgical management of acute paediatric scrotal pain between adult urologists and general surgeons in the UK: an observational study

H N Bermingham et al. Ann R Coll Surg Engl. 2022 May.

Abstract

Introduction: Acute scrotal pain is a common paediatric surgical emergency. Assessment and timely exploration are required to rule out testicular torsion (TT) and prevent unnecessary morbidity.

Methods: A retrospective observational cohort study was carried out at two district general hospitals in the UK for boys aged ≤16 years presenting with acute scrotal pain between January 2014 and October 2017 managed by adult general surgery (AGS) at one hospital and adult urology (AU) at the other.

Results: Some 565 patients were eligible for inclusion (n=364 AGS, n=201 AU). A higher proportion of patients underwent surgical exploration at AGS compared with AU (277/346 (80.1%) vs 96/201 (47.8%); p<0.001). Of those who underwent exploration, 101/373 (27.1%) had TT, of whom 25/101 (24.8%) underwent orchidectomy and 125/373 (33.5%) had torted testicular appendage. There was no statistically significant difference in rates of orchidectomy between AGS (19/68, 27.9%) and AU (6/33, 18.2%) with testicular salvage rates of 72.1% and 81.8%, respectively (p=0.334). Patients were twice as likely to be readmitted at AGS as at AU (28/346 (8.1%) vs 8/201 (4.0%); p=0.073).

Conclusion: Although intraoperative findings were similar between adult general surgeons and urologists, there were significant differences in surgical management, with a higher rate of surgical exploration by general surgeons. Testicular salvage and 30-day postoperative morbidity rates at both institutions were acceptable but the readmission rate was high at 6.6%. It is not known why there is a heterogeneity in management of acute scrotal pain between specialist centres, and further prospective investigations are warranted.

Keywords: Acute scrotal pain; General surgery; Paediatric surgery; Testicular torsion; Urology.

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Figures

Figure 1
Figure 1
Flow diagram of study patient selection and number of patients with confirmed testicular torsion
See this image and copyright information in PMC

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