Akutes Skrotum - Evaluierung der Ursachen nach operativer Therapie

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).