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> I am personally aware of cases in which surgical exploration has been delayed after successful manual detorsion only to find a necrotic testical in the OR. I would be very cautious with this practice.
--> A few points:
1. The delay here was NOT caused by the "successful maunal detorsion". It was caused by the person who decided to delay, based upon ignorance of what was GUARANTEED by the procedure and, perhpas, by being unaware of how to ENSURE it was indeed successful.
2. If the testis was necrotic in the OR, there is no evidence of the procedure being "successful", unless by this you only mean successful a reducing pain...
3. Can we agree that, if we stop people DELAYING exploration, then any procedure which is demonstrated to have a good chance of alleviating pain and, perhpas, improving testicular survival, IS worthwhile?
4. "Cautious" is fine by me. Good advice. Be that with
- testicular detorsion (risk: delyed exploration)
- giving opiate analgesia for, say, ?appendicitis (risk: we all know that one!)
- giving analgesia for headaches (risk: someone thinking that if analgesia works then the condition is "safe")
- re-aligning dislocated knees to restore perfusion (not patellae) (risk: someone then not realising the need to properly evaluate the popliteal artery)
In all of these and others, your kindness and success in improving the condition may be misinterpreted to mean something else no longer needs doing, so we need to be cautious not to allow that mistake to be made by those others. In other words - don't stop doing good things; just stop others misunderstanding what they mean and delaying NECESSARY URGENT other things...
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