UROLOGY

ResponseTesticular torsion

• Sudden onset, severe pain. Irritable child
• Tender testis, transverse lie, loss of cremasteric reflex
• Needs URGENT surgical correction (Orchidopexy)

Epididymo-orchitis

• Known STD, dysuria, discharge. Febrile with warm hemiscrotum

Torted appendix testis

• May have local trauma. Blue dot sign on examination

Direct inguinal hernia

• Known hernia, post valsalva. Cough impulse, bowel sounds on auscultation, extends from inguinal canal (Can’t get above it). Urgent surgery if irreducible,

Trauma (haematoma, testicular rupture)
Hydrocoele

• transillumination, soft,nontender swelling. Normal testis. Conservative mgmt (stem was “noticed scrotal swelling on nappy change but doesnt’ fit with pain)

ResponseTime critical event
US is secondary priority to clinical assessment by surgeon for suspected torsion
US reserved for cases deemed non urgent by urology/surg, or where you feel torsion unlikely
Escalate to surgical consultant for emergent review with view to theaters
Feedback to surg team at later date
Review existing guidelines

ResponseSend them anyway - urgent++
Escalate to superintendent at both hospitals
Document everything
Incident report
M+M case