The Return

how can one view the US vidoes of the arterial flow waves with EmRap HD???

I've done more than a few of these in the past 40 years. 2 points about manual detorsion:
1. As you rotate, you often get a "detente" stop every 180 degrees - a rather definite "resting" point. It's not a smooth rotation where you can go 90 degrees and see what happens. You go 180 each time.

2. If it is truly a torsion, you will have one or more 180 degree rotations that are easy. Then, the next one (180 degree twist) will be hard, and will go back where that half turn started. When that happens, you are probably done. I'm not aware of ever having gone to far. At that point, you repeat your Ultrasound (or, get your first ultrasound if you were ballsy enough to detorse without first imaging).

3. (I was just kidding, I actually have 3 points). If the testicle won't rotate at all when you try the first half turn rotation - watch carefully here, this may be a difficult concept to grasp - try rotating it the other direction. If that doesn't work, rethink the diagnosis, or if you're certain of the diagnosis, block the cord and try again while the urologist is sharpening her knives.

4. Sorry, can't help myself, one more point. Most of the time, you can do this with a little fentanyl. I prefer this to a cord block, because one can evaluate for cessation of pain if you use fentanyl, whereas with a cord block you can't get a sense of clinical success until the block wears off. Sometimes the pain improves almost immediately with a successful detorsion, Often, it takes 15 minutes or so.

Balls to the walls, guys.

Hi All

So if the US cannot be definitively relied upon to rule out torsion, it would seem from your presentation that you would conceivably need to send each one to the OR for laparoscopy.
But that is not feasible.
What then do you recommend (as opposed to what do you not recommend: do not rely on the neg US)?