Testicular torsion: Difference between revisions
No edit summary |
No edit summary |
||
| Line 5: | Line 5: | ||
{| style="width: 500px" border="1" cellpadding="1" cellspacing="1" | {| style="width: 500px" border="1" cellpadding="1" cellspacing="1" | ||
|- | |- | ||
| '''Rate<br/>''' | | '''Rate'''<br/> | ||
| '''Time'''<br/> | |||
|- | |- | ||
| 90-100% | | 90-100% | ||
| Line 18: | Line 18: | ||
|} | |} | ||
*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%) | |||
==Diagnosis== | *Ultrasound (Doppler) = unilateral abscence of flow (specific) | ||
* Absent cremasteric reflex on affected side (~100%) | |||
* Ultrasound (Doppler) = unilateral abscence of flow (specific) | |||
Note: | Note: | ||
#UA = usually normal (~70%), but the WBC presence can not be relied upon to exclude the diagnosis (30%) | |||
#Ultrasound 88-100% sensitive, 90% specific | |||
==Work-Up== | |||
*UA | |||
*Ultrasound | |||
* UA | |||
* Ultrasound | |||
==DDx== | |||
#torsion of testicular appendage | |||
#epididymitis | |||
#tumor of testicle | |||
Emergent detorsion manual (ER) vs. surgical (urology) | ==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 | To OR or Urology | ||
== See Also == | |||
==See Also== | |||
Insert | Insert | ||
== Source == | |||
==Source== | |||
KajiQuestions | KajiQuestions | ||
Rosens | Rosens | ||
<br/>[[Category:GU]] | |||
[[Category:GU]] | |||
Revision as of 08:21, 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:
- UA = usually normal (~70%), but the WBC presence can not be relied upon to exclude the diagnosis (30%)
- 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