Monday, April 11, 2016

Testicular torsion

emDocs - April 11, 2016 - Authors: Thomas V & Willis J - Edited by: Koyfman A and Long B
  • Testicular torsion is the most common cause of testicular pain occurring in 1/4000 males under 25 years of age; patients with a Bell clapper deformity are more susceptible.
  • Presentation is key with patients reporting severe and sudden pain associated with swelling and tenderness.
  • An absent cremaster reflex is the most sensitive finding but its presence does not completely rule out torsion.
  • Testicular torsion is traditionally diagnosed with ultrasound which will reveal an enlarged testicle, increased echogenicity, and decreased Doppler flow compared to the contralateral testicle.
  • Emergent urology consultation is indicated in order to salvage the testicle; salvage rates are as high as 90% in the first 6 hours, dropping to 20% in after 24 hours.
  • Manual detorsion should only be attempted if surgical intervention is delayed.
  • Torsion of the testicular appendage has a similar presentation but only requires supportive care. It can be confirmed with physical diagnosis and ultrasound.
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