Evaluating Testicular Pain - Yale School of Medicine：评价耶鲁大学医学院的睾丸疼痛.ppt

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Evaluating Testicular Pain - Yale School of Medicine：评价耶鲁大学医学院的睾丸疼痛.ppt

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Evaluating Testicular Pain - Yale School of Medicine：评价耶鲁大学医学院的睾丸疼痛

* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * Evaluating Testicular Pain Kaveh Mansuripur Ambulatory Medicine Clerkship 4/9/09 Learning Objectives By the end of the session, be able to: List the differential dx for testicular pain Label or draw the relevant anatomy Describe the physical examination appropriate for a patient with testicular pain Select appropriate testing for patients with testicular pain in context of specific sxs and signs Select the most appropriate treatment for patients with specific causes of testicular pain Anatomy Case 1: Patient T.R.What is the Differential Diagnosis? HPI: 21 yo man presents with 3 hours of intense, constant testicular pain Began several hours after college track meet Associated nausea and vomiting PMH: None Meds: Glucosamine, condroitin, creatine supplements Alls: PCN FH: Non-contributory SH: Sexually active, multiple partners Differential Diagnosis Testicular Torsion Appendiceal Torsion Epididymitis Trauma Inguinal Hernia Henoch-Schonlein Purpura Mumps Fournier’s Gangrene Referred Pain Case 1: Patient T.R. Exam: Case 1: Patient T.R.What is the Next Step? Exam: Right testicle higher than left Long axis oriented horizontally Significant swelling No cremasteric reflex on either side No relief of pain on elevation Case 1: Patient T.R.Next Step If Diagnosis Certain (Torsion): To the OR. Outcomes directly related to length of time from onset Irreversible ischemia at mean of 12 hours If Diagnosis Less Obvious Doppler Ultrasound Test 82% sensitive, 99% specific for torsion (loss of flow) Case 1: Patient T.R. Operation: testicular detorsion and fixation Unilateral or bilateral? Why? Case 1: Patient T.R. Operation testicular detorsion and fixation Unilateral or bilateral? Why? ANSWER: Bilateral-- Torsion associated with absence/insufficeincy of gubernaculum. Often bilateral. What if surgery not an option? Case 1: Patient T.R. Non-operative: Manual detorsion 2/3 of cases are torsed medially, 1/3 laterally S