Testicular torsion: Difference between revisions

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== See Also  ==
== See Also  ==
[[Torsion of Testicular Appendages]]  
*[[Testicular Pain]]


== Source  ==
== Source  ==

Revision as of 03:38, 21 March 2014

Background

  • Peak incidence in first year of life, 2nd peak incidence at puberty
  • Consider torsion in setting of scrotal trauma if pain persists >1hr
  • Half of all torsions occur during sleep

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

Testicular Diagnoses

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
    • Give parenteral analgesia or perform cord block
      • Prep skin, palpate and grasp cord at external ring and inject 10mL lidocaine directly into cord
    • Hold testicle with left thumb and forefinger
      • Rotate testicle outward 180° in medial to lateral direction
        • Counterclockwise for right testicle and clockwise for left testicle
      • Rotation may need to be repeated 2-3x for complete detorsion/pain relief
      • If difficult to detorse or pain is worse after rotation, try to rotate testicle in opposite direction and observe results.

Disposition

  • To OR or urology

See Also

Source

Tintinalli, Rosen's, ER atlas