Emergency conditions

Question 1

Testicular torsion classifications

Answer 1

Intravaginal (most common)
- Rotation of testicle within sac due to high attachment of tunica vaginalis to spermatic cord.

Extra-vaginal

• Occurs perinatally
• Testes twist before attaching to scrotal wall during development

Testicular appendix
- Torsion of Hydatid of Morgani

Question 2

Risk factors for testicular torsion

Answer 2

Bell Clapper deformity

• Testes not firmly attached to scrotum
• Causes horizontal lie
• Double superior attachment, instead of a superior and inferior attachment

Question 3

Presentation of testicular torsion

Answer 3

Acute onset of testicular/ scrotal pain.

• Vomiting, nausea
• Abdominal/ groin man

Signs

• Erythematous + oedematous scrotal skin
• Horizontal lie
• High riding unilateral testicle
• Absent cremaster reflex (L1-2)

Question 4

Presentation of testicular appendix torsion

Answer 4

Acute scrotal pain that progresses over days

Signs

• Blue dot on upper testicular pole
• Normal cremaster reflex

Question 5

Management of testicular torsion

Answer 5

Analgesia/ anti-nausea
- Codeine, paracetamol

Emergency surgical exploration

• Locates site and corrects torsion.
• Bilateral orchiopexy of testes
• Orchidectomy if testes if necrosed.

Question 6

Investigations

Answer 6

Bloods
- FBC, U+Es+ CRP

Urine dip

Doppler ultrasound
- If it doesn’t delay surgical exploration