Testicular Torsion

Kidney Stones are a Diagnosis of Exclusion!!!











Introduction











* Testicular torsion is a time sensitive diagnosis (risk of infertility, etc)* Commonly mimics kidney stones











History











* Sudden onset pain* Epididymitis tends to be slower in onset* Flank/lower abdomen/scrotal pain* Frequently causes vomiting* Uncommon in geriatric patients











Exam











* Perform a GU exam and look for* Unequal/horizontal “lie”* Testicular tenderness* Swelling* Absent cremasteric reflex











Testing Plan











* Testicular/Scrotal Ultrasound* Urinalysis











Treatment Plan











* Consult urology when suspected (even if ultrasound hasn’t returned yet)* Manual detorsion* “Open the Book”* Twist medial to lateral* Switch directions if no pain relief











Additional Reading











* Flank Pain Practice Case (EM Clerkship)* Pediatric Abdominal Pain (EM Clerkship)