병력/신체검사

주요 질환의 특징적인 증상/징후

	증상	징후
Testicular torsion	Sudden onset Severe pain Associated nausea and vomiting Associated trauma Possible abdominal pain	Asymmetric, high-riding testis Negative Prehn’s sign Absent cremasteric reflex
Epididymitis	Insidious onset Fevers and rigors Lower urinary tract symptoms Relevant sexual history	Indurated testis Tender upper pole of testis Positive Prehn’s sign Intact cremasteric reflex
Torsion of the appendix testis	Gradual onset Moderate to severe pain Associated nausea and vomiting	Localised tenderness to anterior testis ‘Blue dot’ sign

진단 점수제

대표적으로 TWIST score 존재
- 소아에서 testicular torsion 가능성을 평가하기 위한 진단 점수제
- 5가지 항목으로 구성되며 총 점수는 7점

TWIST (Testicular Workup for Ischemia and Suspected Torsion) score

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High risk: 5점 이상

intermediate risk: 3-4점

low risk: 2점 이하

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straight to surgery without imaging

positive predictive value(PPV): 100%

ultrasound: torsion 가능성 평가

scrotal ultrasound 필요없음

negative predictive valueas(NPV): 100%

급성 음낭통의 진단 흐름도

참고자료

비뇨기과학 4판 p180-181, p472-474
American Urological Association. National Medical Student Curriculum. The acute scrotum. Available at http://www.auanet.org/education/auauniversity/medical-student-education/medical-student-curriculum/acute-scrotum
Gordhan CG, Sadeghi-Nejad H. Scrotal pain: Evaluation and management. Korean Journal of Urology 2015;56(1):3.
Centers for Disease Control and Prevention. Sexually Transmitted Diseases Treatment Guidelines, 2015
Srinath H. Acute scrotal pain. Aust Fam Physician 2013;42(11):790–2.
Barbosa JA, Tiseo BC, Barayan GA (2013) Development and initial validation of a scoring system to diagnose testicular torsion in children. J Urol 189: 1859-1864.
Fawzi H, Abdul-Jabbar Lattuf AL-Rudaini ‎M, Abdul Qader Ajaj ‎O. Evaluation of TWIST Score in Predicting Testicular Torsion in Children. Prensa médica argentina 2018;105:1–4.
Sheth KR, Keays M, Grimsby GM, et al. Diagnosing Testicular Torsion before Urological Consultation and Imaging: Validation of the TWIST Score. J Urol 2016;195(6):1870–6.