Since an acute scrotum is in the worst case triggered by a torsion of the testis, which can lead to the destruction of the testicular tissue and thus also to inability to procreate, it is very important in the case of a suspected diagnosis of “acute scrotum” to quickly find the cause in order to be able to immediately initiate an adequate therapy and thus save the tissue. The diagnosis of an acute scrotum is usually already made in the medical history, in which the doctor asks specific questions about the characteristics of the pain. Afterwards, the physician will look for existing symptoms such as redness, swelling and a painful pressure over the testicles during the physical examination.
In order to narrow down the causes of the “acute scrotum” after the working diagnosis, other examinations follow. On the one hand, a urine status is usually determined, by which an inflammatory cause can be identified, and on the other hand testicular sonography (ultrasound examination) plays an important role. If a testicular torsion cannot be excluded in these examinations, a so-called explorative operation follows, in which the cause of the pain is searched for in the open testicle and then treated in the same operation.
Sonography (ultrasound) plays an important role in the diagnosis of the acute scrotum, as in this clinical picture no clear examination result can usually be obtained from the medical history and physical examination alone. A major advantage of sonography is the inexpensive and rapid availability of the method. This is very important in order to quickly reach a clear diagnosis.
In addition, soft tissues, which include the testicular tissue, can be well depicted in sonography. For this purpose, the size (volume) and the sound density of the testis are assessed in a side-by-side comparison and the values determined are compared with standard values. For this purpose, the testicles are fixed with a cloth or also with the hand in such a way that the examiner can attach the transducer of the ultrasound device in the desired position.
Another type of sonography is Doppler sonography. This is an ultrasound method in which the flow of blood in vessels can be well displayed. This flow is very limited in the case of testicular torsion, which can usually be shown well using Doppler sonography.
The therapy of the acute scrotum is different depending on the cause. In the case of testicular torsion, if the testicle cannot be turned back manually, an operation is unavoidable in which the testicle is turned back into its original position (detorquation) and it is then observed whether the undersupplied testicular tissue recovers. If there is an inflammatory cause, antibiotic therapy is the method of choice. In this case, physical protection and cooling of the testicular tissue is also recommended. However, if the testicular tissue cannot be saved and is irrevocably damaged, the therapy consists of its surgical removal in order to avoid infection of the whole body by the dead tissue.