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

• History: Abrupt onset testicular pain a/w N/V
  • May have had intermittent episodes in the past
• Exam: Swollen, high-riding testis w/ transverse lie
  • Absent cremasteric reflex on affected side
• Ultrasound
  • Only indicated for equivocal cases
  • (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 (ED) vs. surgical (urology)

Manual Detorsion

• Not definitive tx!
  • Pt still requires emergent surgical exploration even if successful
• Indicated if urologist is not immediately available
• "Open the book" = twist outward and laterally
  • Hold testicle with left thumb and forefinger
    • Rotate testicle outward 180° in medial to lateral direction
    • Rotation may need to be repeated 2-3x for complete detorsion/pain relief

Disposition

To OR or urology

See Also

Torsion of Testicular Appendages

Source

Tintinalli, Rosen's