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Inpatient Testicular Ultrasound For Epididymoorchitis. A load of balls… or is it?
EP34226
Poster Title: Inpatient Testicular Ultrasound For Epididymoorchitis. A load of balls… or is it?
Submitted on 04 Nov 2020
Author(s): Hui Yen Teh
Affiliations: NHS Lothian
Poster Views: 339
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Poster Information
Abstract: Introduction
Epididymo-orchitis (EO) is the most common cause of an acute scrotum in the post-pubertal male.(1) It normally resolves with appropriate antibiotic therapy. Testicular ultrasound (US) in EO confers little benefit to patients with a consistent clinical presentation of EO as a negative scan does not change clinical management.(2) This study aims to review the role of testicular (US) in management of clinically suspected EO in a large, tertiary Urology Unit in South East Scotland. Do the findings alter patient management?

Methods
Testicular US scan requests for Urology inpatients from January to December 2019 were retrospectively reviewed. The patients who had clinically suspected EO on initial assessment were followed up to evaluate any change in management (defined as surgical intervention) based on their testicular US findings.

Results
73 (79%) out of 94 testicular US conducted were for a clinical suspicion of EO. Of these, 80% revealed either; simple epididymo-orchitis (49%), clinically insignificant hydrocoeles or haematomas (10%) or normal testes (21%). None of these scan results led to change in management from antibiotic therapy. 12 scans (16%) demonstrated complicated EO with abscess or ischaemia of which 9 patients had surgical intervention (3 incision and drainage, 4 orchidectomy, 1 debridement, 1 negative exploration) based on the findings.
Interestingly, 2 scans (3%) revealed EO in the affected testicle however also found an incidental mass lesion in the contralateral testicle. These patients were referred to the testicular cancer pathway and both underwent an orchidectomy for testicular cancer. 1 (1%) scan was grossly abnormal suggesting an infective/inflammatory process with liquefaction. This patient underwent an orchidectomy.

Limitations
This study did not review testicular US scans performed in the outpatient population for clinically suspected EO who are generally younger males with less severe infection.

Conclusions
The majority (80%) of testicular US conducted for clinically suspected EO revealed normal or expected findings which did not change clinical management of appropriate antibiotic therapy.
However, testicular US scans are useful in the management of an inpatient population of suspected EO, where complication rates are higher and surgery may be indicated.
More importantly, there was a high rate of an incidental finding of testicular cancer in this patient group which enabled early staging and definitive surgical management.

Summary: This study aims to review the role of testicular ultrasound in the management of clinically suspected epididymo-orchitis in inpatients in a large, tertiary Urology Unit in South East Scotland. References: 1. Velasquez J, Boniface MP, Mohseni M. Acute Scrotum Pain. [Updated 2020 May 28]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from:https://www.ncbi.nlm.nih.gov/books/NBK470335/
2. Epididymitis - 2015 STD Treatment Guidelines [Internet]. Cdc.gov. 2015 [cited 25 October 2020]. Available from: https://www.cdc.gov/std/tg2015/epididymitis.htm
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