C-MOTH (Conservative Management of Torted Hydatid)
Research type
Research Study
Full title
Conservative Management of Torted Hydatid
IRAS ID
356342
Contact name
Chloe Roy
Contact email
Sponsor organisation
Newcastle University
Clinicaltrials.gov Identifier
N/A, N/A
Duration of Study in the UK
0 years, 5 months, 23 days
Research summary
Acute scrotal pain (ASP) is a common reason for children to attend the emergency department. There are several differential diagnoses, the top of which are testicular torsion (TT), torsion of appendix of testis (TAT), or torted 'hydatid', and epididymo-orchitis (EO). Only testicular torsion requires emergency surgery, in the form of scrotal exploration.
In the UK, assessment of ASP has traditionally been based on history and clinical examination alone, with little utilisation of clinical risk scores, like TWIST (Testicular Workup for Ischemia and Suspected Torsion), or ultrasound. The inability to differentiate between the causes of ASP has, generally, led to a low threshold for scrotal exploration. This has led to a high ‘negative exploration’ rate, i.e. testicular torsion is not present. This is the case in up to 75%. Our group has shown that increased utilisation of TWIST score and ultrasound can reduce this.
A rebuttal to the high negative exploration rate from practitioners who have a low threshold for scrotal exploration is that they often have pre-operative suspicion of TAT and are operating for diagnostic confirmation and symptom relief. However, if an accurate pre-operative diagnosis can be made, a conservative approach would avoid the risks of general anaesthetic and morbidities related to scrotal surgery. But how long will it take for the symptoms of TAT to subside? To our knowledge, this question was last addressed in 1981, where authors report “…most non operated children resume full activities within 2-5days”.
The aim of this study is to perform a contemporary analysis of conservative management of TAT to ascertain the average time for resolution of symptoms, and determine what proportion of patients would have preferred an early surgical approach.
REC name
London - Westminster Research Ethics Committee
REC reference
25/PR/1183
Date of REC Opinion
7 Oct 2025
REC opinion
Further Information Favourable Opinion