396 - Is there utility in obtaining a urinalysis in prepubertal males presenting to the Emergency Department with testicular pain?

Scrotal pain is a complaint often encountered in the pediatric emergency department. The approach to a boy with scrotal pain includes imaging and a urinalysis. There are few studies assessing the utility of a urinalysis in prepubescent boys. Urinary tract infections are uncommon in boys and testicular pain is not a typical presentation.

Objective:

To evaluate the associations between scrotal pain and urinalyses in a cohort of boys presenting to the Pediatric Emergency Department (PED).

Design/Methods:

This was a retrospective chart audit study of male patients who presented to the PED with chief complaint of testicular pain or scrotal pain. Included were boys aged birth to 20 years and excluded were boys with underlying urologic diseases, no urinalysis, and no urine culture obtained. Data was abstracted from the electronic medical records for boys presenting between January 1, 2016 and December 31, 2021.

Results:

There were 1209 patients that presented with testicular pain to the PED. 537 patients did not have a urinalysis performed. Of the remaining 671 patients, 3 were excluded due to neurogenic bladder, recurrent UTIs, or recent cystoscopy. Boys had mean age of 11.7 years (+/- 4.3 yrs), and were 26.8% Hispanic, 18.6% Black, 54.9 % White (Table 1). Of these patients 389 patients (58%) were younger than 13 years with zero positive urinalyses, 6 cultures with contaminants, and no positive urine cultures. Of the 280 pubertal boys, identified three had positive urine cultures: Gram positive coryneform bacillus/cocci, E. coli, and Chlamydia trachomatis.  There were four positive urinalyses. Two were positive for large leukocyte esterase (LE), one of which was also positive for nitrites. One was positive for small LE. One was positive for trace LE.

Conclusion(s):

There were no prepubertal boys presenting with testicular pain and no urinary symptoms who had a urinary tract infection.  Surprisingly, only 2 pubertal boys had a urinary tract infection. Although a few boys had positive urinalyses. This study suggests that routinely evaluating urine in boys with only testicular or scrotal pain is not necessary and could decrease length of stay and medical costs.