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Soru

Zorluk: KolayUrologic Surgery

A 14-year-old boy is brought to the emergency department by his parents due to sudden-onset, severe left testicular pain that awoke him from sleep 2 hours ago. He reports one episode of nonbilious emesis since the pain started. Vital signs are temperature 37.1°C (98.8°F), blood pressure 118/76 mmHg, and heart rate 105/min. Physical examination reveals a swollen, exquisitely tender, and high-riding left testicle with a transverse lie. The cremasteric reflex is absent on the left side but intact on the right. Elevation of the left testicle does not relieve the pain. Which of the following is the most appropriate next step in management?

  1. Immediate surgical explorationCevap
  2. B
    Doppler ultrasound of the scrotum
  3. C
    Intravenous ceftriaxone and oral doxycycline
  4. D
    Manual detorsion and outpatient follow-up
  5. E
    Urinalysis and urine culture

Cevap

Immediate surgical exploration
Immediate surgical exploration is the correct management for acute testicular torsion. This condition is caused by the twisting of the spermatic cord, leading to venous congestion and subsequent arterial compromise (ischemia). The diagnosis is highly likely in an adolescent male presenting with sudden, severe testicular pain, a high-riding testicle with a transverse lie, and an absent cremasteric reflex. Because the testicular salvage rate drops significantly after 6 hours of ischemia, a classic clinical presentation mandates immediate surgical intervention (detorsion and bilateral orchiopexy) without wasting time on diagnostic imaging.

Adım Adım Çözüm

1
Identify the primary clinical syndrome based on the patient's presentation.
The patient has sudden-onset severe testicular pain, an absent cremasteric reflex, and a high-riding, transversely oriented testicle.
These are the hallmark clinical signs of acute testicular torsion, a surgical emergency.
2
Determine the necessity of diagnostic imaging.
No imaging is required.
In cases with a classic clinical presentation of testicular torsion, diagnostic imaging like a Doppler ultrasound wastes critical time and is contraindicated.
3
Select the appropriate definitive management.
Surgical exploration is selected.
Immediate surgical exploration is necessary to untwist the spermatic cord, restore blood flow, and perform bilateral orchiopexy to prevent future torsion.

Anahtar Kavram

Patients with classic signs of testicular torsion (abrupt onset, absent cremasteric reflex, high-riding testicle) require immediate surgical exploration without delaying for ultrasound imaging.
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