Emergency: Testicular torsion

Question 1

Define testicular torsion? Which age group are commonly affected by this?

Answer 1

Urological emergency!

Twisting of the testicle around the spermatic cord due to inadequate attachment of tissues within the scrotum.

Males aged 12-18 years but can occur at any age.

Question 2

Causes of testicular torsion?

Answer 2

Inadequate tissue attachment around the testicle, which allows the testis to freely rotate within the scrotum.

Bell-Clapper deformity
- testis is inadequately fixed, allowing it to rotate freely.

Undescended testicle
- Testicles that have not descended fully into the scrotum may be more prone to torsion.

Trauma

Prior intermittent torsion

Question 3

Presentation of testicular torsion?

Answer 3

• severe unilateral testicular pain
• affected testicle may upwards and horizontal in the scrotum
• Unilateral loss of cremaster reflex
• Abnormal testicular lie (often horizontal)
• Rotation, so that epididymis is not in normal posterior position
• Persistent pain despite elevation of the testicle (negative Prehn’s sign)
• n+v due to pain
• minor trauma

Question 4

Diagnosis/IVx of testicular torsion?

Answer 4

Doppler US
- reduced or absent blood flow to the affected testicle.

Urinalysis
- rule out infection, urinary tract inflammation

IVx should NOT delay manangement.

Question 5

Management of testicular torsion?

Answer 5

Urgent surgical exploration -CONFIRMS DIAGNOSIS (whirlpool signs -spiral sign of the spermatic cord and blood vessels)

Bilateral orchidopexy
- Fixation of both testicles is performed to prevent future torsion.

Question 6

Complications of testicular torsion?

Answer 6

Testicular necrosis
Impaired fertility