Paediatrics Flashcards
Define testicular torsion
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
Describe epidemiology of testicular torsion
- Bimodal - extra vaginal affecting neonates in the perinatal period, and intra-vaginal affecting males at any age (most commonly adolescent)
- In males under 25, annual incidence is 1 in 4000 in the US
- Generally doesnt affect the elderly
List risk factors for testicular torsion
- Under 25 (12-18)
- Neonate
- Bell clapper deformity (testicles rotate freely within the tunica vaginalis)
- Trauma/exercise
- Intermittent testicular pain
- Undescended testicle
- Cold weather
List symptoms of testicular torsion
- Testicular pain
- Intermittent or acute on-and-off pain
- No pain relief on elevation of the scrotum
- Nausea and vomiting
- Abdominal pain
- Fever and urinary frequency
List signs of testicular torsion
- Scrotal swelling or oedema
- Scrotal erythema
- Reactive hydrocele
- High riding testicle
- Horizontal lie
- Absent cremasteric reflex
- Prehns sign (not relieved by lifting testes)
List investigations of testicular torsion
- Grey-scale ultrasound (fluid and whirlpool sign)
- Power doppler ultrasound (absent or decreased blood flow in the affected testicle)
- Colour doppler ultrasound (absent or decreased blood flow)
- Spectral doppler (asymmetrical vascular perfusion)
- Urinalysis
- FBC
- CRP
- Scintigraphy (decreased uptake)
- Exploratory surgery
Describe treatment of testicular torsion in non-neonates
- Immediate urological consultation for emergency scrotal exploration + morphine + ondansetron
- Fix other side
- Alternatively manual de-torsion with scrotal exploration (open book method) + morphine + ondansetron
Describe treatment of testicular torsion in neonates
With torsion at birth
- Initial stabilision, urological consultation and semi-elective scrotal exploration + morphine sulfate and ondansetron)
With normal testes at birth
- Emergency scrotal exploration. Fixing testes (orchidopexy) with 3 stitches, on both sides to prevent recurrence.
- Morphine sulfate and ondansetron
List complications of testicular torsion
- Infarction of testicle/ permanent testicular damage/ loss of testicles
- Infertility
- Psychological implication (offer prosthetic device)
- Cosmetic deformity
- Recurrent torsion
- Impaired pubertal development
Describe prognosis of testicular torsion
- 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.
- Can recur
Describe hydatid of morgagni
- A torsion of the appendix testes
- Will heal itself and fall off.
- Presents similarly to testicular torsion.
- Blue dot sign on testicle may be seen
