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Testicular Torsion Medication

  • Author: Oreoluwa I Ogunyemi, MD; Chief Editor: Edward David Kim, MD, FACS  more...
 
Updated: Dec 11, 2015
 

Medication Summary

Analgesic and antianxiety medications are valuable adjuncts in the treatment of testicular torsion. Pain control is essential to quality patient care. It ensures patient comfort, promotes pulmonary toilet, and enables physical therapy regimens. Antiemetics can be used to counter the nausea and vomiting that may accompany testicular torsion.

Studies have looked at anti-inflammatory adjuncts to testicular torsion in the rat model. Phosphodiesterase type-5 inhibitors and statin medications have been shown to decrease inflammatory markers and to increase blood flow to the testicles. These adjuncts are still in the research stage and are not clinically available for this use.[38]

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Analgesics

Class Summary

Most analgesics have sedating properties, which are beneficial for patients who have sustained painful trauma.

Morphine sulfate (Duramorph, Astramorph, MS Contin, Kadian)

 

Morphine is the drug of choice for narcotic analgesia due to reliable and predictable effects, safety profile, and ease of reversibility with naloxone.

Various IV doses are used; the dose is commonly titrated until the desired effect is obtained.

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Antiemetics

Class Summary

These agents are used to prevent nausea and vomiting.

Prochlorperazine (Compro)

 

Prochlorperazine may relieve nausea and vomiting by blocking postsynaptic mesolimbic dopamine receptors through its anticholinergic effects and depressing the reticular activating system. In addition to its antiemetic effects, it has the advantage of augmenting hypoxic ventilatory response, acting as a respiratory stimulant at high altitude.

Metoclopramide (Reglan, Metozolv)

 

Metoclopramide blocks dopamine receptors in the chemoreceptor trigger zone of the central nervous system.

Ondansetron (Zofran)

 

Odansetron is a selective 5-HT3-receptor antagonist that blocks serotonin both peripherally and centrally. It prevents nausea and vomiting, including that associated with emetogenic cancer chemotherapy (eg, high-dose cisplatin), and complete body radiotherapy.

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Antianxiety Agents

Class Summary

These agents are used to reduce anxiety.

Diazepam (Diastat, Valium)

 

Diazepam modulates the postsynaptic effects of gamma-aminobutric acid–A (GABA-A) transmission, resulting in an increase in presynaptic inhibition. It appears to act on part of the limbic system, the thalamus, and hypothalamus, to induce a calming effect. It also has been found to be an effective adjunct for the relief of skeletal muscle spasm caused by upper motor neuron disorders.

Diazepam rapidly distributes to other body fat stores. Twenty minutes after initial IV infusion, the serum concentration drops to 20% of maximum plasma concentration (Cmax).

Individualize dosage and increase cautiously to avoid adverse effects.

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Contributor Information and Disclosures
Author

Oreoluwa I Ogunyemi, MD Resident Physician, Department of Urology, University of Wisconsin Hospitals and Clinics

Oreoluwa I Ogunyemi, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American Urological Association, National Medical Association

Disclosure: Nothing to disclose.

Coauthor(s)

E Jason Abel, MD Assistant Professor of Urologic Oncology, Department of Urology, University of Wisconsin Hospital and Clinics, University of Wisconsin School of Medicine and Public Health; Attending Urologist, William S Middleton Memorial Veterans Hospital

Disclosure: Nothing to disclose.

Madelyn Weiker University of Wisconsin School of Medicine and Public Health

Madelyn Weiker is a member of the following medical societies: American Medical Student Association/Foundation

Disclosure: Nothing to disclose.

Chief Editor

Edward David Kim, MD, FACS Professor of Surgery, Division of Urology, University of Tennessee Graduate School of Medicine; Consulting Staff, University of Tennessee Medical Center

Edward David Kim, MD, FACS is a member of the following medical societies: American College of Surgeons, Tennessee Medical Association, Sexual Medicine Society of North America, American Society for Reproductive Medicine, American Society of Andrology, American Urological Association

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Repros.

Acknowledgements

Leslie Tackett McQuiston, MD, FAAP Assistant Professor of Surgery (Urology) Dartmouth Medical School; Staff Pediatric Urologist, Dartmouth-Hitchcock Hospital

Leslie Tackett McQuiston, MD, FAAP is a member of the following medical societies: American Academy of Pediatrics and American Urological Association

Disclosure: Nothing to disclose.

Eugene Minevich, MD Assistant Professor, Department of Surgery, Division of Pediatric Urology, University of Cincinnati

Eugene Minevich, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Surgeons, and American Urological Association

Disclosure: Nothing to disclose.

Raymond Rackley, MD Professor of Surgery, Cleveland Clinic Lerner College of Medicine at Case Western Reserve University; Staff Physician, Center for Pelvic Medicine and Pelvic Reconstruction, Glickman Urological Institute, Cleveland Clinic Foundation

Raymond Rackley, MD is a member of the following medical societies: American Urological Association

Disclosure: Pfizer, Novartis, Proctor & Gamble, Allergan Honoraria None; Pfizer, Novartis, Proctor & Gamble, Allergan Consulting fee Other

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

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Testicular torsion: (A) extravaginal; (B) intravaginal.
A 17-year-old adolescent boy with a 72-hour history of scrotal pain.
Intraoperative findings in testicular torsion.
Transverse power Doppler image of both testes illustrates an enlarged, avascular left testicle.
Testicular torsion. Transverse color Doppler image of the left groin illustrates an undescended testicle without flow.
 
 
 
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