The following is a summary of “Conservative management of scrotal pyoceles – A case series and literature review,” published in the May 2023 issue of Emergency Medicine by Brancati, et al.

For a study, researchers sought to describe the common presenting signs and symptoms, treatment modalities, and outcomes of acutely presenting scrotal pyoceles.

A retrospective chart review was conducted, including adult patients with ultrasound-confirmed scrotal pyoceles treated between 2010 and 2020 at two sites. Data collected included vital signs at presentation, microbiology results, antibiotic treatment, and surgical procedures during hospitalization.

A total of 360 scrotal ultrasounds were reviewed, identifying 15 patients with pyoceles. Among them, 11 patients presented to the emergency department, and 4 were hospitalized. The most common chief complaint was testicular pain (67%). Only seven patients (47%) met the systemic inflammatory response syndrome (SIRS) criteria upon presentation. All patients initially received broad-spectrum antibiotics and were observed. Of these, 11 patients (73%) showed improvement with antibiotic treatment and observation alone, while four patients (27%) required surgical drainage due to persistent infection. There were no cases of Fournier’s gangrene.

The study presented the largest database of scrotal pyoceles to date and outlines our clinical approach to management. Traditionally, surgical drainage has been the preferred treatment for pyoceles. However, the case series suggested that most patients can be successfully managed with broad-spectrum antibiotic treatment and observation, reserving surgical drainage for cases where infection persists. Further investigations, including multi-institutional data, were needed to validate the institution’s approach.

Source: sciencedirect.com/science/article/abs/pii/S0735675723000554