음낭외상시 고환파열에 대한 초음파 검사의 진단적 유용성

Abstract

Purpose: To determine the diagnostic use of ultrasonography for evaluation of scrotal injury, we undertook a retrospective study of patients presenting to our hospital with scrotal trauma. Materials and Methods: We reviewed 54 patients of scrotal trauma in the last 8 years. Forty patients were evaluated by ultrasonography preoperatively. Among them, 33 cases underwent scrotal exploration and 7 cases were managed conservatively. The remaining 14 patients were evaluated only by physical examination, 8 patients of them were explored immediately because of suspicious testicular rupture. The accuracy of ultrasonography were determined by comparing radiographic interpretations with intraoperative findings. Results: Among the 33 patients who were evaluated by ultrasonography and explored immediately, there were 26 suspected testicular ruptures on ultrasonography. Surgical exploration revealed testicular rupture in 23 and simple hematoma in 10. The testicular rupture was correctly diagnosed by ultrasonography in the 22 cases, and there were 4 false-positive and 1 false-negative diagnoses of testicular rupture. The sensivity and specificity for the diagnosis of testicular rupture are 96% and 60%, and the positive and negative predictive values are 85% and 86%, respectively. Among the 8 patients who had suspected testicular rupture only on physical examination and were explored immediately, there were 3 testicular ruptures who were correctly diagnosed by physical examination resulting in 37.5% positive predictive values. The majority of testicular ruptures were salvaged with only 4 of the 26(15%) requiring orchiectomy, and all patients treated conservatively were resolved successfully. Conclusions: Ultrasonography is noninvasive and effective diagnositic method in scrotal trauma. If it is used in conjunction with a physical examination, it is highly accurate in identifying testicular rupture and supports the need for immediate surgical exploration in patients with scrotal injury.