Testicular torsion

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
  • (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

1. torsion of testicular appendage
2. epididymitis
3. tumor of testicle

Treatment

• Emergent detorsion
  • Manual (ED) vs. surgical (urology)

Manual Detorsion

• 26% success rate
• "Open the book" = twist outward and laterally

For Right Testicle

1. stand in front of standing or supine patient
2. hold right testicle with left thumb and forefinger
3. rotate the right testicle outward 180° in a medial to lateral direction
4. rotation may need to be repeated 2-3 times for complete detorsion/pain relief

For Left Testicle

1. stand in front of standing or supine patient
2. hold left testicle with right thumb and forefinger
3. rotate the left testicle outward 180° in a medial to lateral direction
4. rotation may need to be repeated 2-3 times for complete detorsion/pain relief

Disposition

To OR or urology

Source

Tintinalli, Rosen's