Scrotal Swellings

Dr. Vivek Rege
Scrotal Swellings - Treatment
The dilemma in such a case is assuming the cause to be EO, the treatment is medical; however, if the diagnosis is then found to be torsion, the testis is lost permanently. On the other hand, if the child is operated on assuming it is torsion and it turns out to be EO, then the operation would have been unnecessary and unindicated. In this type of a case my philosophy is, when in doubt, assume all cases are torsion of the testis and operate the child to look for the torsion of testis. This operation is undertaken after a full detailed explanation of the pros and cons to the parents of the boy, their consent is taken. The advantages of this approach no torsion will be missed or remain uncorrected after the child is brought to the surgeon for opinion and advice; there is no wastage of valuable time for searching traveling to and from a Sonologist who will be doing the Doppler study and not being definitely sure about the final diagnosis based on the interpretation of the study. It is better to explore and find that the diagnosis is EO rather than conserve, treat medically and later find this was a case of torsion.

In cases of torsion - the testis is explored, untwisted, and observed. The color, consistency, pulsations are looked for to confirm that the testis is viable. After confirming that the testis is alright, it is reposited into the scrotum and fixed in position with a stitch going through the testis and the skin of the scrotum to prevent a recurrence of the torsion. Even more important, the opposite side testis must always be fixed at the same sitting with a suture. This is done because, the same congenital anomaly that was responsible for torsion on one side, may be present on the opposite side, and fixing the opposite side testis would prevent torsion from occurring on that side in the future. This is very important to remember.

In case of EO, an oral broad spectrum antibiotic is started for the infective pathology, additionally, an anti-inflammatory drug is begun to take care of the inflammation and the edema. Elevation of the scrotum with local cold compresses are also started. This therapy is continued till the swelling and tenderness begin to recede. More important in these cases is to investigate the child for urological defects after the episode settles. A complete urinary tract investigation must include Ultrasound for kidneys, ureters and bladder, a MCU to look for reflux, obstruction of the lower urinary tract, and an IVP to look for anomalies of the upper urinary system like double or ectopic ureters etc.

Scrotal Swellings Scrotal Swellings 03/01/2005
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