Diagnostic accuracy of C-reactive protein and erythrocyte sedimentation rate in patients with acute scrotum

Our aim was to investigate the diagnostic efficacy of C-reactive protein [CRP] and erythrocyte sedimentation rate [ESR] in patients with acute scrotum. One hundred and twenty patients with an acute scrotum were evaluated and assigned into 3 groups: 46 had acute epididymitis [group 1], 23 had spermatic cord torsion [group 2], and 51 had other noninflammatory causes of acute scrotum. Serum samples of all patients taken at the time of admission were tested for CRP levels and ESR. An at least 4-fold increase in the serum CRP levels was seen in 44 patients [95.6%] in group 1 [mean, 67.77 +/- 47.80 mg/L]. In contrast, only 1 patient in group 2 had a significant increase in serum CRP level [mean, 9.0 +/- 4.90 mg/L]. The patients in group 3 did not experience any significant increase of CRP levels [mean, 7.0 +/- 2.2 mg/L]. The patients with epididymitis had higher CRP and ESR values than others [P <.001; P <.001]. The best cutoffs were 24 mg/L for CRP and 15.5 mm/h for ESR to differentiate between epididymitis and noninflammatory causes of acute scrotum. The sensitivity and specificity were 93.4% and 100% for CRP and 95.6% and 85.1% for ESR, respectively. Based on our findings, serum levels of CRP and ESR can provide helpful information easily and rapidly for differentiation between epididymitis and other causes of acute scrotum. We suggest CRP and ESR be measured before making a decision of surgical exploration

Acute urinary retention in children

Acute urinary retention in children is a relatively rare entity. There are a variety of causes that are poorly defined in the literature. We review our cases of acute urinary retention in children at three major pediatrics centers in Iran. Between 1996 and 2003, children [up to 14 years old] who had been referred due to acute urinary retention were examined. Urinary retention was defined as inability to empty the bladder volitionally for more than 12 hours with a urine volume greater than expected for age or a palpably distended bladder. All data from the patients' past medical history, physical examination, and laboratory and radiographic assessments were collected. Also, cystourethroscopy and urodynamic procedures had been carried out according to patient's conditions. Patients with secondary urinary retention, including those with surgical history, immobility or chronic neurological disorders, mental retardation, and drugs or narcotics consumption were excluded from study. There were 86 patients meeting the inclusion criteria, consisting of 58 males with a median age of 4 years [range 1 month to 14 years] and 58 females with a median age of 4 years [range 4 month to 14 years]. Etiologies were lower urinary tract stone in 27.9%, neurological disorders in 10.4%, trauma in 10.4%, local inflammatory causes in 9.1%, urinary tract infection in 7.4%, ureterocele in 7.4%, benign obstructing lesions in 5.8%, iatrogenic in 5.8%, constipation in 4.6%, imperforated hymen in 3.5%, and large prostate utricle, urethral foreign body, and rhabdomyosarcoma each in 1 case [1.1%]. The most common cause of acute urinary retention was lower urinary tract stone in our pediatric cases. Ureterocele and stone were the main findings in girls and boys, respectively, and urinary retention in boys was twice as prevalent as that in girls