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تعداد آیتم قابل مشاهده باقیمانده: 4

The acute scrotum: suggested disposition and treatment

The acute scrotum: suggested disposition and treatment
Testicular torsion Torsion of appendage Acute epididymitis
Indications for surgery: Admission criteria: Admission criteria:
  • Suggestive history or physical examination
  • Similar episodes >2 weeks ago
  • No flow or spermatic cord knot by Doppler ultrasound
  • Diagnostic uncertainty
  • Testicular torsion excluded
  • Severe pain
  • Pain refractory to trial of analgesics and conservative management
  • Testicular torsion excluded
  • Severe pain
  • Immunocompromised
  • Not tolerating oral medications or noncompliant
Treatment: Treatment: Treatment:
  • Definitive: surgery
  • Temporizing: trial of manual detorsion
  • Analgesics
  • Rest
  • Children:
    • If pyuria >3 WBC/hpf or positive culture, or if underlying GU abnormality:
      • Antibiotic course against coliforms*
    • If no pyuria and negative culture:
      • Antibiotics not required
      • Extensive evaluation not required
  • Sexually active adolescents:
    • Heterosexual: empiric antibiotics (chlamydia, GC)Δ
    • Homosexual: empiric antibiotics (chlamydia, GC and coliforms)Δ

GC: gonorrhea; GU: genitourinary; HPF: high power field; WBC: white blood cell.

* Antibiotic choices include: Trimethoprim (TMP)-sulfamethoxazole (6-12 mg TMP component/kg per day divided every 12 hours) or cephalexin (25-50 mg/kg per day divided every 6 to 8 hours).

¶ Significant overlap in clinical findings and diagnostic studies may occur for testicular torsion, torsed appendage, or acute epididymitis. Exploratory surgery may ultimately be necessary to determine the etiology of scrotal pain.

Δ Refer to the UpToDate topics on sexually transmitted infections.
Adapted with permission from: Burgher, SW. Acute scrotal pain. Emerg Med Clin North Am 1998; 16:781.
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