Ep 144 Testicular Torsion: A Diagnostic Pathway

Emergency Medicine Cases

Dr. Anton Helman

Science, Courses, Medicine, Health & Fitness, Education

4.7 • 602 Ratings

🗓️ 28 July 2020

⏱️ 36 minutes

🔗️ Recording | iTunes | RSS

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Summary

In this Part 2 of Urologic Emergencies EM Cases main episode podcasts Dr. Natalie Wolpert and Dr. Yonah Krakowsky answer questions about testicular torsion including: when, after the onset of symptoms, is the testicle salvageable? How sensitive is the presence of cremasteric reflex in ruling out testicular torsion? Are there any set of clinical symptoms and signs or decision tools (such as the TWIST Score) that can rule in or rule out testicular torsion with confidence? How accurate is doppler ultrasound in the diagnosis of testicular torsion? To what degree does Prehn's sign help distinguish epididymitis from testicular torsion? How can you distinguish testicular torsion from torsion of testicular appendage? When is manual de-torsion indicated and how effective is it? and many more...

Transcript

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0:00.0	Welcome to the Emergency Medicine Cases Podcast.
0:05.4	I'm your host, Dr. Anton Hellman, bringing you Canada's brightest minds in emergency medicine from EMC Studios in Toronto.
0:15.7	This is part two of our two-part series on urologic emergencies with doctors Natalie Wolpert and Yona Krakowski.
0:21.9	In part one, we cover the management nuances of priapism and urinary retention.
0:27.0	If you haven't already, try out the 10-question quiz we posted in the EM cases quiz
0:31.5	vault to help solidify your knowledge from that podcast. In this podcast, we're going to discuss a urologic emergency
0:39.3	that unfortunately is missed more often than we'd like, because as you'll hear, the history,
0:45.2	the physical, and even imaging can be misleading. After that, Dr. Kukowski is going to hit
0:51.7	us with three common urologic related things that he wished ED docs knew about or did that they sometimes overlook.
0:59.2	Let's start off with the case.
1:00.9	A 20-year-old previously healthy man comes in at 4 a.m. with one hour of excruciating right testicular pain that radiates to his right-lower quadrant and right flank.
1:09.8	He's been vomiting.
1:12.2	There's no fever, no preceding lower quadrant and right flank. He's been vomiting. There's no fever,
1:19.6	no preceding lower urinary tract infection symptoms, nothing else on history. As you walk into the room, he's still vomiting. Looks like he's excruciating pain. So this case is a relatively straightforward one. We're all thinking this could be
1:29.7	testicular torsion, but often these cases aren't so straightforward, and often the classic
1:35.1	symptoms and signs are not present. Hence the fact that about 30% of cases of failed
1:40.3	testicular salvage can be attributed to misdiagnosis and another 13% to delay in treatment
1:47.0	after the diagnosis has been made. So we all know that time is testes, but what can we be
1:55.0	definitive about when it comes to salvaging the testes from time of onset? Is there a time beyond which we can safely
2:02.8	presume that the testicle is dead and we don't need to rush to definitive treatment? Dr. Kikowsky?
2:10.3	I think the answer to that is probably no. We know the rates of salvage are much higher the sooner
2:15.7	to the presentation. It's not that dissimilar from the priapism conversation we had. It's no blood flow to the testes.
	...

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