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Torsion of Testicular Appendage

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21. CRACKCast E093 – Appendicitis

from 8-20 cm in length – which is why the pain can be almost anywhere! 1) List 8 DDx for this condition ALL PATIENTS FEMALE PATIENTS PEDIATRIC PATIENTS Nonspecific abdominal pain Gastroenteritis Epiploic appendagitis Ureterolithiasis, nephrolithiasis Inflammatory bowel disease Ileus or bowel obstruction Intestinal perforation Testicular torsion (males) Ectopic pregnancy Ovarian torsion Pelvic inflammatory disease Ovarian cyst Henoch-Schönlein purpura Mesenteric lymphadenitis Meckel’s diverticulum 2 (...) the right leg as it is flexed at the hip Sensitivity: 8 Specificity: 94 4) McBurney’s point tenderness has a low correlation with appendiceal location and is not highly sensitive for appendicitis, tenderness at this location does have a modest predictive value for appendicitis. 5) “A genitourinary examination should be performed to assess for testicular pathology or hernias in males and pelvic pathology in females. Cervical motion tenderness (CMT) is not specific for pelvic pathology and is noted in 28

2017 CandiEM

22. CRACKCast E099 – Urological Disorders

False negatives with: Early in the course of the disease, intermittent torsion Think about the ddx Torsion of the testicular appendage Epididymitis Management: Consult urology ASAP (even if U/S is negative if you have a high pre-test probability for TT) Attempt manual detorsion if no immediate urologist available Analgesia and antiemetics [3] Describe the treatment for sexually vs. non-sexually acquired epididymitis Epididymitis: Think STI vs. urinary tract abnormality Most common intrascrotal (...) of the ipsilateral testicle is considered evidence of a normal reflex. This reflex normally is absent in 50% of male infants younger than 30 months.” [1] List causes of acute scrotal swelling by age groups (infant, child, adolescent, adult) Infant Child Adolescent Adult Hernia Hydrocele Hernia Torsion Epididymitis Epididymitis Torsion Trauma Epididymitis Hernia Trauma Tumor Torsion Fournier’s gangrene [2] Describe the physiology, diagnosis and management of testicular torsion Bimodal onset: <1 yr and at puberty

2017 CandiEM

24. Scrotal pain and swelling

Scrotal pain and swelling Scrotal pain and swelling - NICE CKS Share Scrotal pain and swellings: Summary Common, or important causes of scrotal swelling include: Testicular cancer. Squamous cell carcinoma of the scrotum. Testicular torsion (torsion of spermatic cord). Torsion of a testicular or epididymal appendage. Epididymo-orchitis. Epididymal cyst, or spermatocele. Varicocele. Hydrocele. Haematocele. To identify the cause of scrotal swelling, the man or boy should be asked about: Presence (...) should be performed in all male patients presenting with abdominal pain. If testicular torsion or torsion of an appendage of the testis or epididymis is suspected, the person should be admitted immediately to urology or paediatric surgery. The man or boy should be examined for: Position of the swelling in relation to the testis. Tenderness. Testicular lie. Size of the testis. Consistency of the swelling. Lymphadenopathy or an abdominal mass. Prehn sign. Transillumination. Features of inguinal hernia

2019 NICE Clinical Knowledge Summaries

25. Paediatric Urology

Epidemiology, aetiology and pathophysiology 12 3C.2 Diagnostic evaluation 12 3C.3 Disease management 12 3C.4 Recommendations for the management of hydrocele 12 3D ACUTE SCROTUM IN CHILDREN 13 3D.1 Epidemiology, aetiology and pathophysiology 13 3D.2 Diagnostic evaluation 13 3D.3 Disease management 14 3D.3.1 Epididymitis 14 3D.3.2 Testicular torsion 14 3D.3.3 Surgical treatment 14 3D.4 Follow-up 14 3D.4.1 Fertility 14 3D.4.2 Subfertility 14 3D.4.3 Androgen levels 15 3D.4.4 Testicular cancer 15 3D.5 (...) without associated patency of the processus vaginalis are encountered in newborns also [60]. Non-communicating hydroceles, based on an imbalance between the secretion and reabsorption of this fluid, are found secondary to minor trauma, testicular torsion, epididymitis, varicocele operation or may appear as a recurrence after primary repair of a communicating or non-communicating hydrocele. 3C.2 Diagnostic evaluation The classic description of a communicating hydrocele is that of a hydrocele

2015 European Association of Urology

26. Acute Onset of Scrotal Pain ? without Trauma, without Antecedent Mass

or epididymo-orchitis, torsion of the spermatic cord, or torsion of the testicular appendages. Quick and accurate diagnosis of acute scrotum and its etiology is necessary because a delayed diagnosis of torsion for as little as 6 hours can cause irreparable testicular damage [1,2]. The single most common cause for acute scrotal pain is epididymitis. There are approximately 600,000 cases of epididymitis diagnosed every year in the United States [3]. Infection is commonly seen in patients 19 to 25 years (...) of age, and overwhelmingly is the etiology for acute scrotum in patients >25 years of age [3]. Torsion is rare in patients >35 years of age [4]. Acute scrotum in prepubertal boys occurs most commonly from torsion of the testicular appendages, a process that can mimic testicular torsion or epididymo-orchitis [2,4]. The pathognomonic physical examination finding of the “blue dot sign” is infrequently encountered [1]. Perinatal testicular torsion is not uncommon, accounting for 10% of cases in children

2014 American College of Radiology

28. Thrombosed varicocele - a rare cause for acute scrotal pain: a case report. (PubMed)

Thrombosed varicocele - a rare cause for acute scrotal pain: a case report. Acute scrotal pain has various causes. Testicular torsion, torsion of appendages and Epididymo-orchitis are common causes, while varicocele thromboses are a rare cause. Varicocele thromboses can occur post operatively or spontaneously. Five cases of post-operative and five cases of spontaneous thromboses have been described till date. The traditional advice in the management of thrombosed varicocele has been to manage

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2018 BMC Urology

29. AIUM Practice Parameter for the Performance of an Ultrasound Examination in the Practice of Urology

of scrotal pain, including but not limited to testicular trauma, ischemia/ torsion, and infectious or inflammatory scrotal disease; • Evaluation of palpable inguinal, scrotal, or scrotal masses; • Evaluation of scrotal asymmetry, swelling, or enlargement; • Evaluation of potential scrotal hernias; • Detection/evaluation of varicoceles; • Evaluation of male infertility; • Follow-up of prior indeterminate scrotal ultrasound findings; • Localization of undescended testes; • Detection of occult primary (...) possible Doppler frequencies (typically in the 5- to 10-MHz range) providing optimal resolution and flow detection should be used. The Doppler frequency may differ from the imaging frequency. Standoff pads can be used, if necessary, to improve imaging. Suggested Reading 1. Akin EA, Khati NJ, Hill MC. Ultrasound of the scrotum. Ultrasound Q 2004; 20:181–200. 2. Baldisserotto M, de Souza JC, Pertence AP, Dora MD. Color Doppler sonography of normal and torsed testicular appendages in children. AJR Am J

2011 American Institute of Ultrasound in Medicine

30. To Assess Effects of Arbaclofen ER Tablets Compared With Placebo on Sperm Parameters in Male Subjects With MS

to the pelvic or groin area; Has a condition that affects spermatogenesis, such as recent severe genitourinary infections and prostatitis; Has had previous prostate surgery or vasectomy; Has been diagnosed by a urologist with any one of the following diseases: Hydrocele of the tunica vaginalis; Hematocele; Torsion of the spermatic cord; Torsion of the testicular appendage; Varicocele II or more severe seminal vesiculitis; Gangrene on the skin of the scrotum; Cryptorchidism, small testis (12 mL, testicular

2016 Clinical Trials

31. Epididymitis

in Epididymitis and >24 mg/L in most cases is typically normal in processing time may preclude use to triage (96%) (92%) testing (PCR l swab or first-void urine) PCR PCR XII. Imaging: Color doppler Scrotal Ultrasound Indications Consider in all cases where cannot otherwise be excluded Differentiates Epididymitis and (increased blood flow) from (absent blood flow) Epididymitis Epididymis with increased blood flow, hyperemia and swelling Decreased or absent testicular blood flow Torsion of appendix Appendage (...) and unilateral pain may recur if torsion is intermittent (rare in Epididymitis) may also present with sudden unilateral and often comorbid with Epididymitis Symptoms of (rare in ) l discharge Urinary urgency X. Signs Epididymis inflammation Tenderness to palpation at the epididymis, superior and posterolateral to Epididymis is enlarged and indurated Adjacent scrotal and testicular inflammation may occur with or infection and both cause testicular swelling, scrotal erythema, reactive present in both

2018 FP Notebook

32. Family Practice Notebook Updates 2016

, place the higher (4-5th intercostal space) Prepare well in obese patients (good light, wide exposed area, longer incision, reposition /axillary fat/arm) (cd, , ) is common ( s A, C, B1, B3, B6, B9, B12) Deficiency syndromes include , , and Pellegra (urology, ) and are unreliable and should not be used alone to rule-out is the study of choice in torsion evaluation, but can miss Even at 6-48 hours after symptom onset, testicular salvage rates may be as high as 50% (nicu, er) Do not endotracheal (...) with , or s Invasive management in refractory cases include and left atrial appendage ablation (lung, cv) is idiopathic or genetic, rare and has specific treatments Four secondary types include left heart disease, lung disease, chronic PE or miscellaneous (e.g. sickle cell) is often delayed 4 years or more despite multiple evaluations/ s Consider in progressive on exertion or is the first line diagnostic tool, evaluating pulmonary pressures and right ventricular function Reviewed (cv, ekg, pe) Acute in PE

2018 FP Notebook

33. Family Practice Notebook Updates 2016

, place the higher (4-5th intercostal space) Prepare well in obese patients (good light, wide exposed area, longer incision, reposition /axillary fat/arm) (cd, , ) is common ( s A, C, B1, B3, B6, B9, B12) Deficiency syndromes include , , and Pellegra (urology, ) and are unreliable and should not be used alone to rule-out is the study of choice in torsion evaluation, but can miss Even at 6-48 hours after symptom onset, testicular salvage rates may be as high as 50% (nicu, er) Do not endotracheal (...) with , or s Invasive management in refractory cases include and left atrial appendage ablation (lung, cv) is idiopathic or genetic, rare and has specific treatments Four secondary types include left heart disease, lung disease, chronic PE or miscellaneous (e.g. sickle cell) is often delayed 4 years or more despite multiple evaluations/ s Consider in progressive on exertion or is the first line diagnostic tool, evaluating pulmonary pressures and right ventricular function Reviewed (cv, ekg, pe) Acute in PE

2017 FP Notebook

34. Urinary Tract Infection, Males (Treatment)

by epididymitis, torsion of the spermatic chord, and torsion of a testicular appendage. Torsion of the spermatic cord must be assumed until proven otherwise, because unresolved torsion of the cord is likely to result in irreversible necrosis in less than 12 hours. Consultation with a urologist is mandatory in all but the most clear-cut cases for operative salvage of the torsed testicle. The surgical intervention is detorsion and orchidopexy, with orchidopexy of the contralateral side (because this side (...) is predisposed to torsion at a later date). Previous Next: Pyelonephritis Therapy Most patients with pyelonephritis should undergo imaging studies to rule out other lesions, and IV antibiotic treatment should be initiated empirically with an aminoglycoside and ampicillin. Third- and fourth-generation cephalosporins, a carbapenem, or aztreonam also provides broad gram-negative rod coverage. Fluid resuscitation is important if the blood pressure is unstable or if the patient is very old. IV antibiotics

2014 eMedicine.com

35. Teratoma, Cystic (Overview)

. [ ] Sacrococcygeal teratomas may be diagnosed antenatally during routine ultrasounds, fetal anomaly scans, or when the mother presents with clinical symptoms such as size greater than dates or polyhydramnios. [ ] Mature cystic teratomas of the ovary are often discovered as incidental findings on physical examination, during radiographic studies, or during abdominal surgery performed for other indications. Testicular teratomas most often present as a painless scrotal mass, except in the case of torsion (...) . [ ] In 1831, Leblanc coined the term dermoid cyst in the veterinary literature when he removed a lesion that resembled skin at the base of a horse's skull, which he called a “kyste dermoid.” [ ] Both dermoid and teratoma, terms now more than a century old, remain in general use and often are used interchangeably, with various preferences among subspecialties. The earliest implications were that elements similar to skin and its appendages comprised dermoids, while teratomas had no such limits. Dermoids now

2014 eMedicine.com

36. Urinary Tract Infection, Males (Follow-up)

by epididymitis, torsion of the spermatic chord, and torsion of a testicular appendage. Torsion of the spermatic cord must be assumed until proven otherwise, because unresolved torsion of the cord is likely to result in irreversible necrosis in less than 12 hours. Consultation with a urologist is mandatory in all but the most clear-cut cases for operative salvage of the torsed testicle. The surgical intervention is detorsion and orchidopexy, with orchidopexy of the contralateral side (because this side (...) is predisposed to torsion at a later date). Previous Next: Pyelonephritis Therapy Most patients with pyelonephritis should undergo imaging studies to rule out other lesions, and IV antibiotic treatment should be initiated empirically with an aminoglycoside and ampicillin. Third- and fourth-generation cephalosporins, a carbapenem, or aztreonam also provides broad gram-negative rod coverage. Fluid resuscitation is important if the blood pressure is unstable or if the patient is very old. IV antibiotics

2014 eMedicine.com

37. Urinary Tract Infection, Male (Follow-up)

by epididymitis, torsion of the spermatic chord, and torsion of a testicular appendage. Torsion of the spermatic cord must be assumed until proven otherwise, because unresolved torsion of the cord is likely to result in irreversible necrosis in less than 12 hours. Consultation with a urologist is mandatory in all but the most clear-cut cases for operative salvage of the torsed testicle. The surgical intervention is detorsion and orchidopexy, with orchidopexy of the contralateral side (because this side (...) is predisposed to torsion at a later date). Previous Next: Pyelonephritis Therapy Most patients with pyelonephritis should undergo imaging studies to rule out other lesions, and IV antibiotic treatment should be initiated empirically with an aminoglycoside and ampicillin. Third- and fourth-generation cephalosporins, a carbapenem, or aztreonam also provides broad gram-negative rod coverage. Fluid resuscitation is important if the blood pressure is unstable or if the patient is very old. IV antibiotics

2014 eMedicine Emergency Medicine

38. Teratoma, Cystic (Diagnosis)

. [ ] Sacrococcygeal teratomas may be diagnosed antenatally during routine ultrasounds, fetal anomaly scans, or when the mother presents with clinical symptoms such as size greater than dates or polyhydramnios. [ ] Mature cystic teratomas of the ovary are often discovered as incidental findings on physical examination, during radiographic studies, or during abdominal surgery performed for other indications. Testicular teratomas most often present as a painless scrotal mass, except in the case of torsion (...) . [ ] In 1831, Leblanc coined the term dermoid cyst in the veterinary literature when he removed a lesion that resembled skin at the base of a horse's skull, which he called a “kyste dermoid.” [ ] Both dermoid and teratoma, terms now more than a century old, remain in general use and often are used interchangeably, with various preferences among subspecialties. The earliest implications were that elements similar to skin and its appendages comprised dermoids, while teratomas had no such limits. Dermoids now

2014 eMedicine.com

39. Epididymitis

age 25. Acute scrotal pain in prepubertal boys occurs most commonly from torsion of the testicular appendages, a process that may clinically mimic testicular torsion or epididymo-orchitis. [ , , ] Preferred examination Radiography has no role in the evaluation of epididymitis. The preferred imaging examination is ultrasonography, which is very useful in the detection of the epididymitis and/or epididymo-orchitis (see the following images). Ultrasonography is helpful in distinguishing acute (...) associated with nausea and vomiting but without fever or other urologic symptoms. A history of intermittent scrotal pain is uncommon in epididymitis or torsion of the testicular appendages but may occur with intermittent testicular torsion. [ ] Testicular cancer and trauma may also cause scrotal pain. The typical patient presentation for paratesticular rhabdomyosarcoma (RMS) is a painless scrotal mass, or symptoms of metastasis, such as inguinal lymphadenopathy, fatigue, decreased appetite and weight

2014 eMedicine Radiology

40. Urinary Tract Infection, Male (Treatment)

by epididymitis, torsion of the spermatic chord, and torsion of a testicular appendage. Torsion of the spermatic cord must be assumed until proven otherwise, because unresolved torsion of the cord is likely to result in irreversible necrosis in less than 12 hours. Consultation with a urologist is mandatory in all but the most clear-cut cases for operative salvage of the torsed testicle. The surgical intervention is detorsion and orchidopexy, with orchidopexy of the contralateral side (because this side (...) is predisposed to torsion at a later date). Previous Next: Pyelonephritis Therapy Most patients with pyelonephritis should undergo imaging studies to rule out other lesions, and IV antibiotic treatment should be initiated empirically with an aminoglycoside and ampicillin. Third- and fourth-generation cephalosporins, a carbapenem, or aztreonam also provides broad gram-negative rod coverage. Fluid resuscitation is important if the blood pressure is unstable or if the patient is very old. IV antibiotics

2014 eMedicine Emergency Medicine

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