December 17, 2010Welcome Applicants!

Sudden onset of severe unilateral painmay radiate to inguinal area or lower abdomen+/- Nausea and vomiting (90%)

Consider as secondary event

Has been reported post-orchiopexy

4 to 8hrs12hrs 20% viable24hrs nonviableConsult urology immediately!!

Orchiopexy: surgical detorsion and fixation of both testes

Orchiectomy is performed if the testicle is nonviable

Manual Detorsion: “Open Book” rotationMedial to lateral

Give appropriate sedation and analgesia

Still need surgical exploration after manual detorsion

Not necessary if strong clinical suspicionDoppler U/S (69-100% sensitive, 77-100%

specific)Nuclear Scan measuring testicular perfusion

(100% sensitive, 97% specific)

Most commonly caused by infectionSexually Active Males: CT is #1, followed by

GC, E.Coli, and virusesLess Common: Ureaplasma, Mycobacterium,

CMV, Cryptococcus in HIV+Pre-adolescents

Infectious: Mycoplasma, Enteroviruses, Adenoviruses

Non-infectious: may be caused by “chemical inflammation” from reflux of sterile urine

Risk FactorsStructural abnormalitiesSexual activityAgeHeavy physical exertionBicycle/Motorcycle riding

UA and UCx should be obtainedRestrospective study: only 15% of patients with

Epididymitis had a positive UAUCx is often negative

When GC/CT suspected:Ceftriaxone 250mg IM x 1 + Doxycycline

100mg PO BID x 14 daysQuinolones no longer recommended

For Enteric Organisms: Levofloxacin 500mg PO Qday x 10 daysOfloxacin 300mg PO BID x 10 days

Bacterial Causes (if they have associated UTI):Bactrim or Cephalexin

Non-Bacterial Causes: Supportive Measures (NSAIDs, Bed Rest, Scrotal Support, possibly Abx)