Testicular torsion
Background
Salvage Rates for Detorsion Times
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