Testicular torsion: Difference between revisions
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**Pt still requires emergent urology consult even if successful | **Pt still requires emergent urology consult even if successful | ||
*"Open the book" = twist outward and laterally | *"Open the book" = twist outward and laterally | ||
**Give parenteral analgesia or perform cord block | |||
***Prep skin, palpate and grasp cord at external ring and inject 10mL lidocaine directly into cord | |||
**Hold testicle with left thumb and forefinger | **Hold testicle with left thumb and forefinger | ||
***Rotate testicle outward 180° in medial to lateral direction | ***Rotate testicle outward 180° in medial to lateral direction | ||
****Counterclockwise for right testicle and clockwise for left testicle | ****Counterclockwise for right testicle and clockwise for left testicle | ||
***Rotation may need to be repeated 2-3x for complete detorsion/pain relief | ***Rotation may need to be repeated 2-3x for complete detorsion/pain relief | ||
***If difficult to detorse or pain is worse after rotation, try to rotate testicle in opposite direction and observe results. | |||
== Disposition == | == Disposition == |
Revision as of 04:10, 14 January 2013
Background
- Peak incidence in first year of life, 2nd peak incidence at puberty
- Consider torsion in setting of scrotal trauma if pain persists >1hr
- Half of all torsions occur during sleep
Salvage Rates for Detorsion Times
Rate |
Time |
90-100% | <6 hrs |
20-50% | 6-12 hrs |
0-10% | >24 hrs |
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 (99% Sn)
- Ultrasound
- Only indicated for equivocal cases
- Unilateral abscence of flow (specific)
Work-Up
- UA
- US for equivocal cases
- Lab workup for surgery
DDx
- Torsion of testicular appendage
- Epididymitis
- Testicular mass
- Incarcerated hernia
Treatment
- Manual (ED) vs. surgical (urology)
Manual Detorsion
- Indicated if urologist is not immediately available
- Not definitive tx
- Pt still requires emergent urology consult even if successful
- "Open the book" = twist outward and laterally
- Give parenteral analgesia or perform cord block
- Prep skin, palpate and grasp cord at external ring and inject 10mL lidocaine directly into cord
- Hold testicle with left thumb and forefinger
- Rotate testicle outward 180° in medial to lateral direction
- Counterclockwise for right testicle and clockwise for left testicle
- Rotation may need to be repeated 2-3x for complete detorsion/pain relief
- If difficult to detorse or pain is worse after rotation, try to rotate testicle in opposite direction and observe results.
- Rotate testicle outward 180° in medial to lateral direction
- Give parenteral analgesia or perform cord block
Disposition
- To OR or urology
See Also
Torsion of Testicular Appendages
Source
Tintinalli, Rosen's, ER atlas