Cpt Code For Manual Detorsion Of Testicle

Detorsion Of Testicle
Manual Detorsion Of Testicle
Cpt Code For Manual Detorsion Of Testicle - Intensivesquared

Therefore, CPT code 49320 is included in CPT codes 38120, 38570- 38572, 43280, 3, 7, 44970, 0, 3, 1, 2, 55550, 4, 58660- 58673, and 60650. CPT code 58555 is included in CPT codes 58558- 58565.
Testicular torsion is a clinical diagnosis and the primary goal is surgical detorsion in the operating room. If testicular torsion is strongly suspected clinically, consult a Urologist immediately for a bedside evaluation. Manual detorsion can be attempted while awaiting more definitive surgical intervention.
Emergent urology consultation is indicated in order to salvage the testicle; salvage rates are as high as 90% in the first 6 hours, dropping to 20% after 24 hours. Manual detorsion should only be attempted if surgical intervention is delayed. Torsion of the testicular appendage has a similar presentation but only requires supportive care.

Testicular size is often diminished, and injury to the unaffected testicle is common. The effect of a torsion event on long-term fertility is not fully understood. A repeat doppler ultrasound scan may confirm restoration of blood flow to the testicle following manual detorsion. However, surgical exploration is often performed in order to assess. Manual detorsion is not a safe procedure, since testicular torsion is also possible to the opposite direction. The success of the manual detorsion should lead to clinical improvement and visible testicular perfusion in Doppler ultrasound imaging. After successful manual detorsion, scrotal orchidopexy of both sides should be done within the next.

Table of Contents

Indications of Manual Detorsion

It can serve as a temporizing measure to attempt to reperfuse the testis while the patient is awaiting definite surgical management.

Contraindications of Manual Detorsion

Manual detorsion is not recommended for torsion of duration >6-8 hours (prolonged ischemia leads to marked swelling and edema after which manual detorsion is not effective)
Manual detorsion should not delay scrotal exploration and bilateral orchipexy in the operating room.
It is indicated only in acute testicular torsion. Attempting this maneuver in epididymitis and torsion of appendix testis although may not be harmful, will be extremely painful and of no benefit.

Procedure of Manual Detorsion

Testis twist with inward rotation in 70% cases of testicular torsion and the average number of twist in cord is 2 (720 degrees).

1. A dose of analgesic and/or short-acting axiolytic may be used to blunt the discomfort of detrosion.

2. Physician is positioned in front of the standing or supine position.

3. Affected testicle is held with thumb and forefinger of the opposite hand, i.e. physician’s right hand for left testicle and physician’s left hand for right testicle.

4. Testis should be turned caudal to cranial (lifting slightly upward to release cremasteric reflex) and 180 degrees or more from medial to lateral (“opening a book”).

5. Rotation of testicle may need to be repeated 2-3 times for complete detorsion.

6. If the first attempt is unsuccessful, the testis should be turned in the opposite direction.

Signs or Markers of Successful Detorsion

1. Immediate resolution of pain

2. Restoration of anatomy (resolution of transverse lie of testis to vertical or longitudinal configuration)

3. Eventual return of cremasteric reflex

4. Color doppler ultrasonogram shows return or improvement of flow

Detorsion Of Testicle

5. Lower position of testis in the scrotum

Following successful manual detrosion, elective bilateral orchidopexy is recommended to, to prevent recurrent torsion and protect the contralateral side from torsion.

Manual Detorsion Of Testicle

References:

An Illustrated Guide to Pediatric Urology By Ahmed H. Al-Salem
Essential Emergency Procedures edited by Kaushal Shah, Chilembwe Mason
Textbook of Pediatric Emergency Procedures edited by Christopher King, Fred M. Henretig