Testicular torsion: Difference between revisions
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== Background == | == Background == | ||
*Peak incidence in first year of life, 2nd peak incidence at puberty | |||
*Consider torsion in setting of scrotal trauma if pain persists >1hr | |||
'''Salvage Rates for Detorsion Times''' | '''Salvage Rates for Detorsion Times''' | ||
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| >24 hrs | | >24 hrs | ||
|} | |} | ||
== Diagnosis == | == Diagnosis == | ||
*History: | |||
*History: Abrupt onset testicular pain a/w N/V | **Abrupt onset testicular pain a/w N/V | ||
**May have had intermittent episodes in the past | **May have had intermittent episodes in the past | ||
*Exam: Swollen, high-riding testis w/ transverse lie | *Exam: | ||
**Absent cremasteric reflex on affected side | **Swollen, high-riding testis w/ transverse lie | ||
**Absent cremasteric reflex on affected side (99% Sn) | |||
*Ultrasound | *Ultrasound | ||
**Only indicated for equivocal cases | **Only indicated for equivocal cases | ||
**Unilateral abscence of flow (specific) | **Unilateral abscence of flow (specific) | ||
== Work-Up == | == Work-Up == | ||
*UA | |||
*UA | *US for equivocal cases | ||
* | |||
*Lab workup for surgery | *Lab workup for surgery | ||
== DDx == | == DDx == | ||
#Torsion of testicular appendage | #Torsion of testicular appendage | ||
#Epididymitis | #Epididymitis | ||
#Testicular mass | #Testicular mass | ||
#Incarcerated hernia | #Incarcerated hernia | ||
== Treatment == | == Treatment == | ||
*Manual (ED) vs. surgical (urology) | *Manual (ED) vs. surgical (urology) | ||
=== Manual Detorsion === | === Manual Detorsion === | ||
*Indicated if urologist is not immediately available | *Indicated if urologist is not immediately available | ||
*Not definitive tx | |||
**Pt still requires emergent urology consult even if successful | |||
*"Open the book" = twist outward and laterally | *"Open the book" = twist outward and laterally | ||
**Hold testicle with left thumb and forefinger | **Hold testicle with left thumb and forefinger | ||
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***Rotation may need to be repeated 2-3x for complete detorsion/pain relief | ***Rotation may need to be repeated 2-3x for complete detorsion/pain relief | ||
== Disposition == | == Disposition == | ||
*To OR or urology | |||
To OR or urology | |||
== See Also == | |||
[[Torsion of Testicular Appendages]] | [[Torsion of Testicular Appendages]] | ||
== Source == | == Source == | ||
Tintinalli, Rosen's | Tintinalli, Rosen's | ||
[[Category:GU]] [[Category:Peds]] | [[Category:GU]] [[Category:Peds]] | ||
Revision as of 20:16, 17 August 2011
Background
- Peak incidence in first year of life, 2nd peak incidence at puberty
- Consider torsion in setting of scrotal trauma if pain persists >1hr
Salvage Rates for Detorsion Times
| Rate |
Time |
| 90-100% | <6 hrs |
| 20-50% | 6-12 hrs |
| 0-10% | >24 hrs |
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 (99% Sn)
- Ultrasound
- Only indicated for equivocal cases
- Unilateral abscence of flow (specific)
Work-Up
- UA
- US for equivocal cases
- Lab workup for surgery
DDx
- Torsion of testicular appendage
- Epididymitis
- Testicular mass
- Incarcerated hernia
Treatment
- Manual (ED) vs. surgical (urology)
Manual Detorsion
- Indicated if urologist is not immediately available
- Not definitive tx
- Pt still requires emergent urology consult even if successful
- "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
- Hold testicle with left thumb and forefinger
Disposition
- To OR or urology
See Also
Torsion of Testicular Appendages
Source
Tintinalli, Rosen's