Testicular Torsion


HISTORY & EXAM

DIAGNOSIS

ED Care & Disposition

  1. When the diagnosis is obvious, urologic consultation is indicated for exploration because imaging tests can be too time consuming. Testicular salvage is related to duration of symptoms with excellent salvage rates with < 6 hr of symptoms.
  2. The emergency physician can attempt manual detorsion. Most testes twist in a lateral to medial direction, so detorsion is performed in a medial to lateral direction, similar to the opening of a book. The end-point for successful detorsion is pain relief; urologic referral is still indicated.
  3. Urology is consulted early in the pt's course even when confirmatory testing is planned. When the diagnosis of testicular torsion cannot be ruled out by diagnostic studies or examination, urology consultation is indicated.

 

Scrotum

(+) Mass
(-) Pain
(-) Mass
(+) Pain
(+) Transillumionation (-) Transillumination Epididymitis Torsion
OLD mass, Present since childhood NEW mass on superior pole Steril Pyuria
(+) WBC
ABSENT Cremasteric Reflex
MCC: Chlamydia

Process Vaginalis Tumor

EMERGENCY Urology Consult
indirect hernia Ultrasound Rx:
Ceftriaxone
+
Doxycycline

Not suspicious Suspicious
Elective Repair   CT Abd/Pelv
AFP
HCG
Radical Inguinal Orchiectomy