08.26.2018 - By Zack Olson, MD and Michael Estephan, MD
Kidney Stones are a Diagnosis of Exclusion!!!
Introduction
* Testicular torsion is a time sensitive diagnosis (risk of infertility, etc)* Commonly mimics kidney stones
History
* Sudden onset pain* Epididymitis tends to be slower in onset* Flank/lower abdomen/scrotal pain* Frequently causes vomiting* Uncommon in geriatric patients
Exam
* Perform a GU exam and look for* Unequal/horizontal “lie”* Testicular tenderness* Swelling* Absent cremasteric reflex
Testing Plan
* Testicular/Scrotal Ultrasound* Urinalysis
Treatment Plan
* Consult urology when suspected (even if ultrasound hasn’t returned yet)* Manual detorsion* “Open the Book”* Twist medial to lateral* Switch directions if no pain relief
Additional Reading
* Flank Pain Practice Case (EM Clerkship)* Pediatric Abdominal Pain (EM Clerkship)