Testicular torsion: Difference between revisions

Revision as of 06:00, 6 August 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

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
- Unilateral abscence of flow (specific)

Work-Up

UA (Negative)
Ultrasound
Lab workup for surgery

DDx

Torsion of testicular appendage
Epididymitis
Testicular mass

Treatment

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

Source

Tintinalli, Rosen's

Authors:

@@ Line 1: / Line 1: @@
-== Background ==
+== Background  ==
 '''Salvage Rates for Detorsion Times'''
 {| style="width: 500px" border="1" cellpadding="1" cellspacing="1"
 |-
-| '''Rate'''<br/>
+| '''Rate'''<br>
-| '''Time'''<br/>
+| '''Time'''<br>
 |-
 | 90-100%
-| <6 hrs&nbsp;
+| &lt;6 hrs&nbsp;
 |-
 | 20-50%
 | 6-12 hrs&nbsp;
 |-
 | 0-10%
-| >24 hrs
+| &gt;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
+*scrotal trauma associated with torsion, consider if persistent scrotal pain &gt; 1 hour
-== Diagnosis ==
+== Diagnosis  ==
-*History: Abrupt onset testicular pain a/w N/V
-**May have had intermittent episodes in the past
+*History: Abrupt onset testicular pain a/w N/V
-*Exam: Swollen, high-riding testis w/ transverse lie
+**May have had intermittent episodes in the past
-**Absent cremasteric reflex on affected side
+*Exam: Swollen, high-riding testis w/ transverse lie
-*Ultrasound
+**Absent cremasteric reflex on affected side
-**Only indicated for equivocal cases
+*Ultrasound
+**Only indicated for equivocal cases
 **Unilateral abscence of flow (specific)
-==Work-Up==
+== Work-Up ==
-*UA
-*Ultrasound
-==DDx==
+*UA (Negative)
-#Torsion of testicular appendage
+*Ultrasound
-#Epididymitis
+*Lab workup for surgery
+== DDx ==
+#Torsion of testicular appendage
+#Epididymitis
 #Testicular mass
-==Treatment==
+== Treatment ==
-*Manual (ED) vs. surgical (urology)
-===Manual Detorsion===
+*Manual (ED) vs. surgical (urology)
-*Not definitive tx!
-**Pt still requires emergent surgical exploration even if successful
+=== Manual Detorsion ===
-*Indicated if urologist is not immediately available
-*"Open the book" = twist outward and laterally
+*Not definitive tx!
-**Hold testicle with left thumb and forefinger
+**Pt still requires emergent surgical exploration even if successful
-***Rotate testicle outward 180° in medial to lateral direction
+*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==
+== Disposition ==
-To OR or urology
+To OR or urology
+== See Also ==
+[[Torsion of Testicular Appendages]]
-==See Also==
+== Source  ==
-[[Torsion of Testicular Appendages]]
-== Source ==
+Tintinalli, Rosen's
-Tintinalli, Rosen's
-[[Category:GU]]
+[[Category:GU]] [[Category:Peds]]
-[[Category:Peds]]