The dilemma in the diagnosis of acute scrotum: Clinical clues for differentiating between testicular torsion and epididymo-orchitis

Background: Acute painful scrotum is one of the most challenging urological emergencies. Irreversible parenchymal damage will develop if a testicle is twisted. The aim of the study was to determine the importance of different clinical clues to help differentiate the causes of this devastating condition. Methods: The medical charts of teenagers with acute scrotal pain between January 2003 and December 2008 were reviewed retrospectively. Results: Seventy-six patients were included in this study, including 47 initially suspected of having testicular torsion and 29 suspected of having epididymoorchitis. Testicular torsion was confirmed in 39 of the suspected 47 cases after surgical exploration. Twnety-one of these 39 testicular torsion patients underwent orchiectomy, and 18 were rescued and underwent orchiopexy. The mean pain duration was significantly longer in the orchiectomy group than the orchiopexy group (38.05 hours vs 14.14 hours, p = 0.009). In the testicular torsion group, fewer patients had elevated C-reactive protein levels no patients had pyuria, and the pain duration was shorter compared with the epididymo- orchitis group (5/11 vs 13/22 [p = 0.045], 0/28 vs 8/28 [p = 0.004] and 27.0 vs 74.5 hours [p = 0.0003], respectively). The sensitivity of color Dopper ultrasound in diagnosing testicular torsion and epididymo-orchitis was 84.09% vs 92.59%. Logistic regression for multivariate analysis showed that left side manifestation and pain duration were significantly different between testicular torsion and epididymo-orchitis with odds ratios of 4.76, p = 0.020 and 0.98, p = 0.029, respectively. Conclusions: Pain duration and left side manifestation are independent risk factors of testicular torsion. Prompt surgical exploration should be done if testicular torsion is highly suspected.