Cpt Code For Manual Detorsion Of Testicle

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Indications of Manual Detorsion

Jan 24, 2016 For torsion of the right testicle, the procedure is similar except that the testicle is held using the left thumb and forefinger and the testicle is rotated in a counterclockwise direction. Manual detorsion is successful in 30-70% of patients and is evident by the immediate relief experienced by the patient. Cpt Code For Manual Detorsion Of Testicle. No upcoming events.

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

Testicular salvage drops rapidly from 80 to 100% at 6 to 8 hours to near zero at 12 hours. Fixation of the contralateral testis is also done to prevent torsion on that side. When manual detorsion is successful, bilateral testicular fixation is done electively. After obtaining institutional review board approval, we reviewed the records of 229 adolescent males who presented with testicular torsion to our institution using ICD-9 and ICD-10 codes for testicular torsion (608.20 and N44.00, respectively) and CPT codes for testis detorsion with contralateral fixation or orchiectomy (54600 or 54520.

  1. 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)
  2. Manual detorsion should not delay scrotal exploration and bilateral orchipexy in the operating room.
  3. 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.

Question

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.

Reference

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

Cpt Code For Manual Detorsion Of Testicle - Intensivesquared

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 Testicular Detorsion Under Propofol Sedation

References:

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