[77] Testicular Torsion

Question 1

What is testicular torsion?

Answer 1

When a testicle rotates, twisting the spermatic cord that brings blood to the scortum

Question 2

What occurs as a result of twisting of the spermatic cord?

Answer 2

Reduced blood flow causing sudden and often severe pain and swelling

Question 3

In what age group is testicular torsion most common?

Answer 3

Post-pubertal boys

Question 4

Is testicular torsion limited to post pubertal boys?

Answer 4

No, it can occur at any age including newborns

Question 5

What are the two types of testicular torsion?

Answer 5

• Intravaginal

- Extravaginal

Question 6

What is intravaginal testicular torsion?

Answer 6

When the torsion occurs within the tunica vaginalis

Question 7

What is extravaginal testicular torsion?

Answer 7

When the torsion occurs outside the tunica vaginalis

Question 8

Almost all torsion events in older boys are of which type?

Answer 8

Intravaginal

Question 9

In which age group are extravaginal torsions commonly seen?

Answer 9

Perinatal cases

Question 10

What forms the basis of all torsion events?

Answer 10

Twisting of the spermatic cord

Question 11

When does ischaemia occur in testicular torsion?

Answer 11

When the twist is sufficient to obstruct arterial inflow

Question 12

What can testicular ischaemia result in?

Answer 12

Infarction

Question 13

What do lesser degrees of torsion often result in?

Answer 13

Obstruction of venous outflow?

Question 14

What can venous outflow obstruction lead to?

Answer 14

Congestion and swelling of the testis

Question 15

What is the main risk factor of intravaginal torsion?

Answer 15

Bell clapper deformity

Question 16

What is a bell clapper deformity?

Answer 16

Where the testis lie horizontally within the tunica vaginalis and lack posterior anchoring

Question 17

What are the risk factors for extravaginal torsion?

Answer 17

• Large birth weight
• Difficult labour
• Breech presentation
• Overreactive cremasteric reflex

Question 18

How may testicular torsion present?

Answer 18

• Acute onset pain
• Redness and oedema of scrotal skin
• N & V
• Abnormal teste position
• Absent cremasteric reflex

Question 19

Where may the pain localise in testicular torsion?

Answer 19

Groin or lower abdomen

Question 20

How may the testes be abnormally positioned in testicular torsion?

Answer 20

May be high riding and/or transversely oriented

Question 21

What test is diagnostic of testicular torsion?

Answer 21

Doppler ultrasound

Question 22

What result is seen on doppler ultrasound in torsion?

Answer 22

Absent Doppler signal in testicular parenchyma

Question 23

What is absent Doppler signal indicative of?

Answer 23

Lack of blood supply

Question 24

What test may be useful to rule out infective causes of testicular pain?

Answer 24

Urinalysis

Question 25

If acute torsion is suspected what should not be delayed?

Answer 25

Treatment

Question 26

What are some differentials for torsion?

Answer 26

• Incarcerated hernia
• Epididymitis
• Henoch-Schonlein Purpura
• Orchitis
• Hydrocoele

Question 27

What conservative management technique is used in some cases?

Answer 27

Manual detorsion

Question 28

What does manual detorsion involve?

Answer 28

Untwisting the spermatic cord by manipulating the testis so the anterior surface rotates from medial to lateral

Question 29

What is manual detorsion mostly used for?

Answer 29

Buying time before surgical intervention

Question 30

Why is manual detorsion rarely used?

Answer 30

It is difficult

Question 31

What are the goals of surgery?

Answer 31

• Confirmation of diagnosis
• Assessment
• Detorsion
• (Removal of involved testis if necessary)
• (Fixation of involved testis to prevent recurrence if appropriate)

Question 32

If torsion occurs in one of the testis what may be appropriate in terms of the other?

Answer 32

Fixation to prevent torsion in the future

Question 33

What is the main complication of testicular torsion?

Answer 33

Necrosis and loss of testicle

Question 34

What may occur as a result of removal of testicle(s)

Answer 34

Reduced fertility