A scoping review of historical and contemporary management strategies for paediatric scrotal trauma.

Abstract

Objective: To perform a scoping review of the literature pertaining to paediatric scrotal trauma and to contrast operative with conservative management in this cohort of patients using available data.

Methods: A search of Cochrane, SCOPUS, and EMBASE databases was performed using methods pre-published on PROSPERO. Reporting followed Preferred Reporting Items for Systematic Review and Meta-analysis guidelines. Eligible studies were articles or abstracts published in English describing the management of paediatric scrotal trauma, which reported at least one secondary outcome. The intended primary analysis is to report the management of paediatric scrotal trauma and the outcome based on management.

Results: Thirty-six studies were identified, totaling 253 patients. Then, 91.7% of cases presented with unilateral testicular injury and 94.5% of cases resulted from blunt trauma. Then, 86% of patients presenting with scrotal trauma underwent ultrasound imaging of the scrotum. One hundred twenty-three cases underwent conservative management, 116 cases underwent acute surgical management, and 14 underwent delayed surgical management, with a mean time to an intervention of 3 days. Thirty patients were found to have testicular atrophy, with a mean follow-up of 14 months, of these 30 patients, 63% (n = 19) were conservatively managed, 20% (n = 6) were managed with acute surgical repair, and 17% (n = 5) were managed with delayed surgical repair.

Conclusion: Paediatric testicular trauma is a rare presentation. A high level of suspicion is mandatory when testicular rupture is suspected. Early exploration is warranted in the setting of high risk and provides an excellent chance of testicular salvage.