A Cross-sectional Survey of Urological Emergency Management by General Practitioners, with a Focus on Acute Scrotal Pain and Testicular Torsion in Chad

Abstract

Urological emergencies account for a significant proportion of medical consultations, with acute scrotal pain and testicular torsion being common and high-risk causes. Rapid treatment is essential to preserve testicular function. In Chad, general practitioners are the first point of contact, but their practices had never been studied. Methods: A descriptive, cross-sectional study was conducted in July 2025 among 136 general practitioners in Chad working in public and mixed, urban and rural settings. Participants completed an online questionnaire on urological emergencies, their management, and complications. The analysis was performed using Excel and presented in proportions and absolute values. A total of 136 general practitioners participated in the survey, the majority of whom were men (87.5%) aged 28 to 44. More than half had been practicing for less than five years, and the majority worked in public facilities (65.4%) or in urban areas (53.7%). The most frequently reported urological emergencies were acute urinary retention (79.4%), acute scrotal pain (55.9%), and renal colic (47.1%). Almost all respondents (94.1%) reported seeing young patients with sudden unilateral scrotal pain; 20.6% encountered this at least once a month. The consultation time varied, with 8.8% of patients consulting within an hour and 20.6% after 24 hours. When faced with a painful scrotum without fever, 26.5% of doctors suspected testicular torsion, while 20.6% suggested epididymitis. The majority (97.1%) had already suspected or diagnosed testicular torsion. Management was mainly based on immediate referral to a specialized center (50%), sometimes combined with the prescription of analgesics (50%) or a scrotal ultrasound (14.7%). Testicular necrosis was the most feared complication (94.1%). No physician performed exploratory scrototomy. Chadian general practitioners recognize testicular torsion but have limited surgical skills and face prolonged delays in consultation, increasing the risk of testicular loss. Enhanced training, the development of standardized protocols, clinical simulation, and improved access to specialized centers are essential to optimize care and reduce morbidity.