Søreide Kjetil
Department of Surgery, Stavanger University Hospital, N-4068 Stavanger, Norway.
J Pediatr Surg. 2005 Aug;40(8):1243-7. doi: 10.1016/j.jpedsurg.2005.05.005.
BACKGROUND/PURPOSE: The aim of this study was to present the current experience and evidence relating to surgical evaluation and management of nonrenal genitourinary presentation in children with Henoch-Schönlein purpura (HSP). Henoch-Schönlein purpura is the most common systemic vasculitis in childhood. Presenting symptoms include a rash, arthralgia, abdominal pain, and, frequently, renal involvement. Genitourinary symptoms are infrequently reported; however, surgical evaluation is often required.
A MEDLINE literature search of the last 3 decades was conducted using the terms Henoch-Schönlein purpura in combination with acute scrotum or genitourinary, genital, or related symptoms as the keywords. Reference lists of retrieved articles were reviewed for further relevant articles. Case reports were included when no larger case series were found. Articles of foreign language were included if abstracts proved sufficient information.
Genitourinary manifestations are mainly anecdotally reported. Scrotal pain and swelling were the most frequent nonrenal genitourinary symptoms reported in children with HSP, occurring in about 13% of boys evaluated for HSP. No prospective, population-based reports on genitourinary manifestations in HSP were found, thus making estimation of the true incidence difficult.
A wide variety of nonrenal genitourinary pathology may be expected by surgical evaluation of patients with HSP. Most cases are self-limited in nature. Scrotal symptoms are frequent, but testicular torsion is highly unlikely when the diagnosis of HSP is established. Clinical vigilance should be paid to patients with possible obstructive ureteritis, for whom prompt surgical intervention may be indicated.
背景/目的：本研究旨在介绍有关过敏性紫癜（HSP）患儿非肾性泌尿生殖系统表现的手术评估和管理的当前经验及证据。过敏性紫癜是儿童最常见的系统性血管炎。其表现症状包括皮疹、关节痛、腹痛，且常伴有肾脏受累。泌尿生殖系统症状报道较少；然而，通常需要进行手术评估。
使用“过敏性紫癜”与“急性阴囊”或“泌尿生殖系统”、“生殖器”或相关症状相结合作为关键词，对过去30年的医学文献数据库（MEDLINE）进行检索。查阅检索文章的参考文献列表以获取更多相关文章。若未找到更大规模的病例系列，则纳入病例报告。若摘要提供了足够信息，则纳入外语文章。
泌尿生殖系统表现主要为个案报道。阴囊疼痛和肿胀是HSP患儿最常报道的非肾性泌尿生殖系统症状，在接受HSP评估的男孩中约13%出现。未找到关于HSP泌尿生殖系统表现的前瞻性、基于人群的报告，因此难以估计其真实发病率。
对HSP患者进行手术评估可能会发现多种非肾性泌尿生殖系统病变。大多数病例本质上是自限性的。阴囊症状很常见，但确诊HSP后睾丸扭转的可能性极小。对于可能患有梗阻性输尿管炎的患者应保持临床警惕，可能需要及时进行手术干预。
