Paediatrics

Question 1

What is testicular torsion?

Answer 1

A urological emergency caused by the twisting of the testicle on the spermatic cord leading to constriction of the vascular supply and time-sensitive ischaemia and/or necrosis of testicular tissue

Question 2

What is the aetiology of testicular torsion?

Answer 2

Intra-vaginal torsion is the most common type of testicular torsion. It occurs because of an abnormally high attachment of the tunica vaginalis to the spermatic cord, which allows rotation of the testicle within the sac
Other aetiologies: trauma

Question 3

What is the epidemiology of testicular torsion?

Answer 3

Extra-vaginal torsion most commonly affecting neonates in the perinatal period, and intra-vaginal torsion affecting males of any age but most commonly adolescent boys

Question 4

What are the presenting symptoms of testicular torsion?

Answer 4

History of sudden-onset scrotal pain, often with nausea and vomiting
Scrotal swelling or oedema
Scrotal erythema
No pain relief upon elevation of the scrotum

Question 5

What are the signs of testicular torsion on physical examination?

Answer 5

Scrotal swelling or oedema
Scrotal erythema
High riding testicle: The affected testicle may appear higher than the unaffected testicle
Reactive hydrocele (collection of fluid in the scrotum)
Tenderness and a horizontal lie “bell-clapper deformity” of the affected testicle

Question 6

What are the appropriate investigations for testicular torsion?

Answer 6

-Grey scale ultrasound:
Presence of fluid and the whirlpool sign (the swirling appearance of the spermatic cord from torsion)
-Doppler ultrasound:
Absent or decreased blood flow in the affected testicle

Question 7

What is the management for testicular torsion?

Answer 7

Urgent surgery (surgical exploration) and analgesia (the rapidity of onset should torsion until proven otherwise):
Salvage rate is 100% within 6 hours
Drops to 20% at 12 hours
0% after 24 hours

Question 8

What are the complications of testicular torsion?

Answer 8

Infarction of the testicle/ permanent testicular damage or even loss of testicle
Infertility secondary to loss of testicle
Psychological impact
Recurrent torsion

Question 9

What is the prognosis for patients with testicular torsion?

Answer 9

‘time is testicle’: the longer it takes for diagnosis and definitive repair, the greater the likelihood that the patient will develop tissue necrosis, decreased tissue viability, decreased spermatogenesis, and possible infertility