chapter  19
10 Pages

The acute scrotum

ByDavid FM Thomas

Introduction Acute scrotal pathology represents one of the few real emergencies encountered in paediatric urological practice. Testicular torsion accounts for 80-90% of cases of ‘acute scrotum’ in teenage boys and in view of the high probability of torsion in this age group immediate surgical exploration should be undertaken unless there is compelling evidence of an alternative diagnosis. By contrast, the differential

diagnosis is more varied in prepubertal boys, but it is nevertheless important to recognise that testicular torsion figures prominently as a cause of acute scrotal pathology across the entire paediatric age range. Surgical intervention can sometimes be avoided if a reliable alternative diagnosis, such as torsion of a testicular appendage, can be established rapidly, but it is generally wiser to observe the timehonoured adage: ‘Whenever doubt exists, it is safer to explore.’