IS THE CONSERVATIVE MANAGEMENT OF THE ACUTE SCROTUM JUSTIFIED ON CLINICAL GROUNDS

Objective To determine whether there is justification for a policy of conservative management of acute scrotal emergencies, based on the abi lity to exclude a twisted testicle or the assumption that there is a ' missed torsion' when the duration of symptoms is prolonged. Patients a nd methods The case notes of 209 consecutive emergency scrotal explora tions, carried out in one district general hospital over a 7-year peri od, were reviewed. The decision to operate was based solely on a clini cal diagnosis, with no information from additional radiological invest igations. Results The commonest finding was testicular torsion (39.5%) with an orchidectomy rate of 22%. Only 5% of scrotal torsions occurre d in patients <12 years of age, whereas 26% occurred in those >20 year s of age. In five of 82 cases (6%) of confirmed testicular torsion, th e surgeon did not consider this the most likely diagnosis. With a pain duration of <16 h, 89% of testes were salvaged, but with pain for >16 h this decreased to 25%. In three cases the testis was viable after p ain had been present for >24 h. Conclusion In the absence of supportiv e radiological investigations, a small but significant number of twist ed testes will be missed if conservative management is adopted.