Testicular torsion

Background

Salvage Rates for Detorsion Times

Rate	Time
90-100%	<6 hrs
20-50%	6-12 hrs
0-10%	>24 hrs

• peak incidence in first year of life, 2nd peak incidence at puberty
• scrotal trauma associated with torsion, consider if persistent scrotal pain > 1 hour

Diagnosis

• Absent cremasteric reflex on affected side (~100%)
• Ultrasound (Doppler) = unilateral abscence of flow (specific)

Note:

1. UA = usually normal (~70%), but the WBC presence can not be relied upon to exclude the diagnosis (30%)
2. Ultrasound 88-100% sensitive, 90% specific

Work-Up

• UA
• Ultrasound

DDx

1. torsion of testicular appendage
2. epididymitis
3. tumor of testicle

Treatment

Emergent detorsion manual: (ER) vs. surgical (urology)

Manual Detorsion

"Open the book" = twist outward and laterally

26% success rate

For Right Testicle

1. stand in front of standing or supine patient
2. hold right testicle with left thumb and forefinger
3. rotate the right testicle outward 180° in a medial to lateral direction
4. rotation may need to be repeated 2-3 times for complete detorsion/pain relief

For Left Testicle

1. stand in front of standing or supine patient
2. hold left testicle with right thumb and forefinger
3. rotate the left testicle outward 180° in a medial to lateral direction
4. rotation may need to be repeated 2-3 times for complete detorsion/pain relief

Disposition

To OR or Urology

See Also

Insert

Source

KajiQuestions

Rosens