Presentation Authors: Emily Yura*, Lauren Folgosa Cooley, Jason Cohen, Matthias Hofer, Chicago, IL
Introduction: Scrotal ultrasound (US) use in the setting of blunt scrotal trauma (BST) has been controversial despite multiple studies demonstrating excellent sensitivity in this context. The American Urological Association guidelines on urotrauma do not specifically endorse or discourage the use of US in BST. We used the National Trauma Data BankÂ® (NTDB) to investigate the role of scrotal US in the management of patients with BST.
Methods: Patients who sustained BST were identified in NTDB years 2014 - 2016. Procedure codes were used to identify patients with scrotal US as well as to identify various operative interventions versus observation.
Results: Of 821 trauma cases with BST included in this analysis, preoperative scrotal US was only performed in 141 (17.2%) patients. While all 680 patients (100%) who did not have a scrotal US underwent scrotal exploration, only 39/141 (27.7%) of those with a preoperative US required surgical exploration (p < 0.001). Amongst those who underwent scrotal exploration, those with a preoperative US were far more likely to require orchiectomy, which was performed in 14/39 (35.9%) compared to 105/680 (15.4%) of those without US (OR 15.4%, 3.067 [CI 1.51-6.02], p=0.002); this supports the use of ultrasound in identifying clinically significant injury necessitating orchiectomy. In addition, the use of a preoperative US prevented unnecessary surgery (i.e., operations not associated with orchiectomy, or testicular or spermatic cord repair), with a negative exploration performed in 13/39 (33.3%) versus 445/580 (65.4%) of those with and without US, respectively (OR 0.264 [95% CI 0.129-0.514], p < 0.001).
Conclusions: Overall, the use of scrotal US in the setting of BST aids in the identification of patients with testicular or spermatic cord injury and reduces the odds of an unnecessary scrotal exploration by about 75%. Despite the clear advantages of this test, scrotal US is underutilized in the community in the assessment of BST. In the absence of obvious clinical indicators of testicular or spermatic cord injury, providers should consider performing scrotal US to guide decision making.