Kidney Stones are a Diagnosis of Exclusion!!!

  • Testicular torsion is a time sensitive diagnosis (risk of infertility, etc)
  • Commonly mimics kidney stones
  • Sudden onset pain
    • Epididymitis tends to be slower in onset
  • Flank/lower abdomen/scrotal pain
  • Frequently causes vomiting
  • Uncommon in geriatric patients
  • Perform a GU exam and look for
    • Unequal/horizontal “lie”
    • Testicular tenderness
    • Swelling
    • Absent cremasteric reflex
Testing Plan
  • Testicular/Scrotal Ultrasound
  • Urinalysis
Treatment Plan
  • Consult urology when suspected (even if ultrasound hasn’t returned yet)
  • Manual detorsion
    • “Open the Book”
    • Twist medial to lateral
      • Switch directions if no pain relief
Additional Reading