PONE-D-21-31965How useful is a complete urinary tract ultrasound in orchiepididymitis?PLOS ONE

Dear Dr. Aeschimann,

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In trying to understand this improvement, the role of treatment received from the ER in terms of antibiotic and pain management is unclear. Was there a consistent ER protocol for treatment? Were antibiotics given only when the urinalysis was positive? Was there a standard pain management regimen? The 3 documented UTIs occurred in infants less than 6 months of age. Although they had negative urinary tract ultrasounds, would you advise further evaluation with a VCUG in these patients after the first OE episode?

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Additional Editor Comments:

please address reviewers questions for acceptance

In trying to understand this improvement, the role of treatment received from the ER in terms of antibiotic and pain management is unclear. Was there a consistent ER protocol for treatment? Were antibiotics given only when the urinalysis was positive? Was there a standard pain management regimen? The 3 documented UTIs occurred in infants less than 6 months of age. Although they had negative urinary tract ultrasounds, would you advise further evaluation with a VCUG in these patients after the first OE episode?

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Reviewers' comments:

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Comments to the Author

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Reviewer #1: Yes

Reviewer #2: Yes

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: I Don't Know

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Reviewer #1: Yes

Reviewer #2: Yes

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Reviewer #1: Yes

Reviewer #2: Yes

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5. Review Comments to the Author

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Reviewer #1: The submitted article presents useful data for clinical practice. The submitted statistical analysis is valid, showing diagnosis of GU tract anomalies to be rare. I do not routinely obtain upper tract imaging in patients presenting with orchitis, but there is debate about this, especially in younger boys. The submitted article adds to the evidence that upper tract imaging is not needed.

Reviewer #2: In their retrospective review of 495 boys less than 16 years old presenting to the ER with signs and symptoms of non traumatic acute scrotum over a six year period from 2012 - 2017, the authors reported on 99 boys with their first episode of OE diagnosed by US who had no previously known urinary tract malformation and who also had a complete urinary tract US to rule out an underlying urinary tract malformation. The primary aim was to determine the yield of the screening “complete urinary tract US” in this patient population. None of these ultrasounds identified any underlying urinary tract malformation.

I found this to be a well written and clinically useful manuscript. In addition to the screening urinary tract US data, other findings in this patient population included a very low incidence of UTI (3.1%), inflammatory markers that were indeterminate and noncontributory, and 75% of patients had improved symptoms after 48 hours. In trying to understand this improvement, the role of treatment received from the ER in terms of antibiotic and pain management is unclear. Was there a consistent ER protocol for treatment? Were antibiotics given only when the urinalysis was positive? Was there a standard pain management regimen?

The 3 documented UTIs occurred in infants less than 6 months of age. Although they had negative urinary tract ultrasounds, would you advise further evaluation with a VCUG in these patients after the first OE episode?

Minor corrections: The study dates given in the Abstract are 2011-2017 while in the Methods and Results the dates are 2012-2017. Also, in figure 1 the dates are 2011-2017.

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Reviewer #1: Yes: Paul F Zelkovic, MD

Reviewer #2: No

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How useful is a complete urinary tract ultrasound in orchiepididymitis?

PONE-D-21-31965R1

Dear Dr. Aeschimann,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

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Kind regards,

Israel Franco, M.D.

Academic Editor

PLOS ONE

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