Testicular torsion: Difference between revisions
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==Background== | == Background == | ||
'''Salvage Rates for Detorsion Times''' | |||
{| style="width: 500px" border="1" cellpadding="1" cellspacing="1" | |||
|- | |||
| '''Rate<br/>''' | |||
| '''Time<br/>''' | |||
|- | |||
| 90-100% | |||
| <6 hrs | |||
|- | |||
| 20-50% | |||
| 6-12 hrs | |||
|- | |||
| 0-10% | |||
| >24 hrs | |||
|} | |||
<br/>-peak incidence in first year of life, 2nd peak incidence at puberty | |||
-peak incidence in first year of life, 2nd peak incidence at puberty | |||
-scrotal trauma associated with torsion, consider if persistent scrotal pain > 1 hour | -scrotal trauma associated with torsion, consider if persistent scrotal pain > 1 hour | ||
==Diagnosis== | ==Diagnosis== | ||
Revision as of 08:18, 12 March 2011
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==
-torsion of testicular appendage-epididymitis-tumor of testicle
==Treatment==
Emergent detorsion manual (ER) vs. surgical (urology) ===Manual Detorsion===
"Open the book" = twist outward and laterally26% success rate For Right Testicle:-stand in front of standing or supine patient-hold right testicle with left thumb and forefinger-rotate the right testicle outward 180° in a medial to lateral direction-rotation may need to be repeated 2-3 times for complete detorsion/pain relief For Left Testicle:-stand in front of standing or supine patient-hold left testicle with right thumb and forefinger-rotate the left testicle outward 180° in a medial to lateral direction-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