Usefulness of Manual Reduction in Patients with Acute Scrotum / 대한비뇨기과학회지

ABSTRACT

PURPOSE: We assessed the usefulness of manual reduction in patients with an acute scrotum. MATERIALS AND METHODS: We retrospectively analyzed the data of 61 consecutive males who had undergone surgical exploration for an impression of testicular torsion, focusing on the incidence, duration of symptoms, direction of testicular torsion and results of manual reduction. Of the 61 explorations, there were 46 (75.4%) and 15 (24.6%) cases of testicular torsion and torsion of a testicular appendage, respectively. RESULTS: Of the 46 testicular torsions, the symptoms were localized to the left side in 37 and to the right side in 9. While the mean symptom duration of the 31 in the orchiectomy group (89 hours) was significantly longer than that in the 15 salvaged testes (10 hours, p=0.003), the mean degree of rotation between the two groups was not significant (p=0.196). Information on the direction of testicular rotation was available in 44 cases, with medial rotation having occurred in 31 (70.5%) and lateral rotation in 13 cases. The clinical symptoms were improved in 4 of the 20 patients in who manual reduction was attempted; residual torsion was identified in 2 patients. CONCLUSIONS: Manual detorsion, the fastest way to relieve testicular ischemia, should be performed at an early offstage following presentation. However, in attempting the manual reduction, the urologist should consider the possibility that a quarter of patients with an acute scrotum do not have testicular torsion, with 30% of testicular torsions occurring in the lateral direction. Surgical exploration remains necessary to confirm the causes of an acute scrotum and to correct any residual torsion.