Non-surgical approach Manual detorsion of the torsed testes, may be attempted, but it is usually difficult because of acute pain during the manipulation. This nonoperative distorsion is not a substitute for surgical exploration. If the maneuver is successful, orchiopexy (surgical fixation of both testes to prevent retorsion) must still be performed. This should be done in the immediate future, preferably before the patient leaves the hospital. If full manual reduction of torsion cannot be performed or if there is doubt about the diagnosis and reason to suspect torsion, the scrotum must be explored. Surgical approach The testis must be unwound at operation and inspected for viability. If it is not viable, it should be removed. If the testis is viable then orchiopexy should be performed to prevent recurrence. Whether the affected testis is removed or conserved, the contralateral one should undergo orchiopexy as the risk of recurrence on the other side is otherwise high. Studies Diagnosing Testicular Torsion Color Doppler ultrasonography can confirm testicular torsion if pain is less severe and the diagnosis is in question. If testicular torsion is present, intratesticular blood flow is either decreased or absent which appears as decreased echogenicity, as compared with the asymptomatic testis. In addition, the torsed testicle often appears enlarged. Radionuclide scintigraphy is a diagnostic test that uses a radioisotope to visualize testicular blood flow. Patients with testicular torsion have decreased radiotracer in the ischemic testis, resulting in a photopenic lesion. Radionuclide scintigraphy vs color doppler ultrasonography: Radionuclide scintigraphy procedure has 100% sensitivity, whereas Doppler ultrasonography only has a sensitivity of 88% and a specificity of 90% in detecting testicular torsion. Although scintigraphy may be more sensitive for testicular torsion, ultrasonography is faster and more readily available. This is a critical consideration in a condition that warrants a rapid diagnosis. Color Doppler ultrasonography and scintigraphy demonstrate no statistically significant difference in ability to demonstrate testicular torsion in boys with acute scrotal symptoms and indeterminate clinical presentations. Clinical Reasoning Differential of Groin Pain in an Adolescent Less Likely Diagnoses Inguinal hernia An inguinal hernia is a painless swelling in the inguinal region, which can be enhanced by maneuvers that raise intra-abdominal pressure, such as cough or Valsalva maneuver. The swelling becomes painful and tender when it is incarcerated. Indirect hernia: An indirect inguinal hernia develops as a result of a persistent process vaginalis. The inguinal canal begins in the intra-abdominal cavity at the internal inguinal ring, located approximately midway between the pubic symphysis and the anterior iliac spine. The canal courses down along the inguinal ligament to the external ring, located medial to the inferior epigastric arteries, subcutaneously and slightly above the pubic tubercle. Contents of this hernia then follow the tract of the testicle down
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- Winter '19
- testicular cancer, Testicle, Testicular torsion