Here are my thoughts on this...
1. Torsion should be managed locally if they have a urologist. The transfer process (unless it just is across town) is just more delays in a time sensitive problem. It just seems wrong to transfer a patient with this condition if you have resources who could do it locally but are doing a wallet biopsy or for some other less than honorable reason.
2. If they do not have a urologist, some surgeons are very comfortable treating torsions. We have no pediatric urologist here at the USA and our pediatric surgeons do all of the torsions. My impression is that this has got to be pretty simple surgery in the big scheme of things.
3. Otherwise, if they have no other options, by all means the patient should be timely transferred.
4. BUT, if they have skilled ultrasound technicians, the referring physician can be encouraged to attempt to detorse the testicle manually using ultrasound confirmation before transfer. The caveats to detorsion is that 1/3 of the time the torsion is the opposite direction and you might make things worse. Hence, the importance of the ultrasound. The detorsion, open book technique, is painful, but very fast and in my limited experience can be done with just pain medications and not procedural sedation. The other caveat is that even if you improve blood flow, studies show that the detorsion done manually is often incomplete. So, they should still be transferred. Pain relief for the patient is a very helpful sign.
From: Pediatric Emergency Medicine Discussion List <[log in to unmask]> On Behalf Of Weiner,Evan
Sent: Sunday, January 12, 2020 12:04 PM
To: [log in to unmask]
Subject: [EXT] Testicular Torsion Transfers
For those of you who work at transfer receiving pediatric centers, if a referral hospital (community, adult, etc etc) has a case of highly suspected testicular torsion (US confirmed or clinically), does your center accept those patients unconditionally?
Does your Urology service insist that the referral hospital have its own on call Urologist take the pt to the OR?
Thanks for the input.
Feel free to reply to me directly.
[log in to unmask]
St. Christopher's Hospital for Children
Evan J Weiner MD FAAP FACEP FAAEM
Program Director, Pediatric Emergency Medicine Fellowship
Medical Director, Critical Care Transport Team
St. Christopher's Hospital for Children
160 East Erie Avenue
Philadelphia, PA 19134
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