Background:Testicular torsion is one of the causes of acute scrotum and it requires timely evaluation and surgical treatment. Color Doppler is considered investigation of choice, but it may delay treatment, as, many times, it may not be available for emergency situations. Barbosa et al. created Testicular Workup for Ischemia and Suspected Torsion (TWIST) score based on clinical parameters for clinical diagnosis of testicular torsion. We have evaluated this score in our population.Materials and Methods:We retrospectively calculated TWIST score in patients of acute scrotum admitted to tertiary teaching institute. Patients without complete TWIST score were excluded from the study. The scoring system consisted of testicular swelling (2 points), hard testicle (2), absent cremasteric reflex (1), nausea/vomiting (1), and high-riding testis (1). Statistical analysis was done to evaluate the validity of scores.Results:A total of 118 patients were included in the study, out of which 45 (38%) patients had testicular torsion. The mean age of patients was 16.6 years in testicular torsion patients and 15.2 years in other patients. Cutoff for low-risk and high-risk patients was two and five, respectively. Fifty percent, 26.2%, and 23.8% of patients were present in low-, intermediate-, and high-risk groups. Negative predictive value of TWIST score for low-risk patients was 96.61% while positive predictive value for high-risk patients was 92.86%.Conclusions:TWIST score has high predictive value and can be used for clinical diagnosis of testicular torsion. It can decrease the need of color Doppler in about 50% of cases and can prevent delay in treatment.
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Primary leimyosarcoma of the kidney is extremely rare. The management is unclear due to the limited literature on the subject. The diagnosis should be considered when imaging shows a relatively hypovascular tumor involving one renal pole, with atypical features on microscopy. We report a renal leiomyosarcoma in a 68 year old man, who underwent right radical nephrectomy. A tumor-free surgical margin is the most important prognostic factor. Although various modalities of adjuvant treatment have been tried, the overall prognosis is poor as the tumor is highly aggressive.
Strangulation of penis is a rare clinical entity, which requires urgent urological management to prevent its devastating outcomes. The treatment of penile strangulation is immediate decompression of the constricted penis to facilitate free blood flow. Many different techniques have been described in literature to remove the constricting penile foreign bodies, but there is no universally accepted technique. Each case needs individualized handling in removing the foreign body. The procedure should be done with as little discomfort to the patient as possible and under anesthesia. Here we present to you a case report on a rare case of a metallic ring penile foreign body causing penile strangulation.
Introduction: Premature ejaculation is a complex condition with controversial management modalities. We decided to assess the treatment-seeking behavior of affected couples, which is an indirect indicator of the efficacy of the present management modalities of premature ejaculation. Materials and Methods: Couples, who reported premature ejaculation at our outpatient clinics between January 2015 and December 2016, were enrolled in the study. Patients with acquired causes for premature ejaculation were excluded. Both the partners were administered premature ejaculation diagnostic tool (PEDT) questionnaire separately at the time of initiation of the study and after 1 month. They were asked to report intravaginal ejaculatory latency time (IELT) and their treatmentseeking behavior at these time intervals. The couples were counselled regarding their diagnosis and offered treatment with dapoxetine 30 mg as and when required. Results: A total of 117 couples with an average married life of 5.4 years were enrolled for the study. Among these, 68 had premature ejaculation (PE), 30 had probable PE and 19 had no PE as estimated on PEDT. Post treatment, 55% of couples with PE, 47% of couples with probable PE and 55% of couples without PE wanted to continue treatment seeking despite improvement. Female partners had the desire to seek treatment despite the male partner reporting otherwise. Conclusion: The treatment seeking behavior of the affected couple indicates the inefficacy of the present management modalities of PE. As specialized health care providers, we need to address these concerns to provide a comprehensive solution to their problems.
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