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Priapism. Aspiration of the corpora cavernosa followed by injection of α-adrenergic agents such as phenylephrine through the same needle is demonstrated by combining two syringes with a three-way stopcock. (Photo contributor: David Effron, MD.)
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Testicular torsion is a twisting of the spermatic cord that leads to testicular ischemia and is a surgical emergency. This condition mainly affects neonates and adolescents, but can occur in older adults as well. Common symptoms include acute-onset testicular pain and swelling with an exam revealing a tender testicle lying in a horizontal plane (bell-clapper deformity). Nausea, vomiting, and abdominal pain may be present.
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Management and Disposition
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If testicular torsion is suspected, obtain immediate urologic consultation. Ultrasound is diagnostic (unless intermittent torsion is present), but surgical management should not be delayed for confirmatory imaging as the time to operative intervention predicts testicular viability. Manual detorsion can be attempted if operative management is not immediately available. In roughly two-thirds of cases, testicular torsion occurs in the medial direction, so rotating the testicle away from the midline may temporarily improve blood flow. The common explanation of the maneuver is that of “opening a book” where the direction of rotation of the patient’s right testicle is counterclockwise when viewed from below and the left is clockwise.
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