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December 17, 2010 Welcome Applicants!. Scrotal Pain. Testicular Anatomy. Testicular Torsion. Classic Presentation. Sudden onset of severe unilateral pain may radiate to inguinal area or lower abdomen +/- Nausea and vomiting (90%) Consider as secondary event - PowerPoint PPT Presentation
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December 17, 2010Welcome Applicants!
Sudden onset of severe unilateral painmay radiate to inguinal area or lower abdomen+/- Nausea and vomiting (90%)
Consider as secondary event
Has been reported post-orchiopexy
4 to 8hrs12hrs 20% viable24hrs nonviableConsult urology immediately!!
Orchiopexy: surgical detorsion and fixation of both testes
Orchiectomy is performed if the testicle is nonviable
Manual Detorsion: “Open Book” rotationMedial to lateral
Give appropriate sedation and analgesia
Still need surgical exploration after manual detorsion
Not necessary if strong clinical suspicionDoppler U/S (69-100% sensitive, 77-100%
specific)Nuclear Scan measuring testicular perfusion
(100% sensitive, 97% specific)
Most commonly caused by infectionSexually Active Males: CT is #1, followed by
GC, E.Coli, and virusesLess Common: Ureaplasma, Mycobacterium,
CMV, Cryptococcus in HIV+Pre-adolescents
Infectious: Mycoplasma, Enteroviruses, Adenoviruses
Non-infectious: may be caused by “chemical inflammation” from reflux of sterile urine
Risk FactorsStructural abnormalitiesSexual activityAgeHeavy physical exertionBicycle/Motorcycle riding
UA and UCx should be obtainedRestrospective study: only 15% of patients with
Epididymitis had a positive UAUCx is often negative
When GC/CT suspected:Ceftriaxone 250mg IM x 1 + Doxycycline
100mg PO BID x 14 daysQuinolones no longer recommended
For Enteric Organisms: Levofloxacin 500mg PO Qday x 10 daysOfloxacin 300mg PO BID x 10 days
Bacterial Causes (if they have associated UTI):Bactrim or Cephalexin
Non-Bacterial Causes: Supportive Measures (NSAIDs, Bed Rest, Scrotal Support, possibly Abx)