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

• 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