Paediatrics

Question 1

What is testicular torsion?

Answer 1

A twist of the spermatic cord resulting in testicular ischaemia and necrosis

Question 2

What is the epidemiology of testicular torsion?

Answer 2

Most common in males aged between 10 and 30 (peak incidence 13-15 years)

Question 3

What are the features of testicular torsion?

Answer 3

Pain is usually severe and of sudden onset - may be referred to the lower abdomen
Nausea and vomiting may be present

Question 4

What are the signs of testicular torsion on examination?

Answer 4

Usually a swollen, tender testis retracted upwards
The skin may be reddened
Cremasteric reflex is lost
Elevation of the testis does not ease the pain (Prehn’s sign)

Question 5

What is the management of testicular torsion?

Answer 5

Urgent surgical exploration
If a torted testis is identified then both testis should be fixed as the condition of bell clapper testis is often bilateral