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Hurdles to boys with acute scrotal pain being evaluated and treated in district general hospitals: we are not Getting It Right the First Time yet

Lookup NU author(s): Milan Gopal, David Macafee, Krishna Eswaravakasudha Radha

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This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).

Abstract

INTRODUCTION: Testicular torsion is a time-critical emergency, though its incidence in the paediatric age group is relatively rare. Changes in training pathways have led to a decreasing number of adult general surgical and urological trainees being comfortable in performing an emergency scrotal exploration in children, resulting in children being transferred to regional units with the requisite expertise. This delay has been shown to increase the risk of orchidectomy. There is, therefore, an increased emphasis on the diagnostic evaluation of these children by emergency department staff. METHODS: We explore how lack of experience and availability of appropriate investigations led to transfer of children presenting to a district general hospital in the North East of England. RESULTS: Children with true testicular torsion in this cohort had an unacceptably high rate of needing an orchidectomy (∼67%) compared with the reported incidence of orchidectomy with testicular torsion (∼20%). CONCLUSIONS: We offer potential solutions to the hurdles that have to be overcome to improve this service. This will align the service to the recently published Get It Right First Time report on the management of testicular torsion in children and young adults and is within the remit of Operational Delivery Networks.

Publication metadata

Author(s): Gopal M, Ibrahim U, Salphale I, Mostafizur M, Walker S, Clement M, Macafee D, Patel A, Balu R, Eswaravaka Sudha Radha KS

Publication type: Article

Publication status: Published

Journal: Annals of the Royal College of Surgeons of England

Year: 2025

Volume: 107

Issue: 7

Pages: 473-478

Print publication date: 01/09/2025

Online publication date: 03/04/2025

Acceptance date: 14/08/2024

Date deposited: 09/09/2025

ISSN (print): 0035-8843

ISSN (electronic): 1478-7083

Publisher: The Royal College of Surgeons of England

URL: https://doi.org/10.1308/rcsann.2024.0078

DOI: 10.1308/rcsann.2024.0078

PubMed id: 40178401

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