Renal & Urology / Scrotal pain and swelling, Testicular Torsion

Question 1

What conditions can cause scrotal pain?

Answer 1

• testicular torsion
• torsion of the appendix testis or epididymis
• epdidymitis
• incarcerated inguinal hernia
• Henoch-Schonlein pupura
• orchitis

Question 2

What conditions can cause scrotal swelling or a scrotal mass?

Answer 2

• Hydrocele
• varicocele
• nonincarcerated inguinal hernia
• spermatocele
• nephrotic syndrome
• testicular cancer
• sperm granuloma (postvasectomy)

Question 3

What is the bell clapper deformity?

Answer 3

• A deformity where the testicle lacks a normal attachment to the tunica vaginalis.
• If the lower pole of the testis is inadequately attached to the tunica vaginalis, the testis may twist on the spermatic cord.

Question 4

What is the incidence of testicular torsion?

Answer 4

• 1 in 4000 males younger than 25 yrs old
• there is a small peak in the neonatal period and large one in puberty though torsion can occur at any age

Question 5

Why is testicular torsion seen more commonly in adolescence?

Answer 5

• the increased incidence is thought to be from the increasing weight of testes during puberty

Question 6

what signs and symptoms are seen with testicular torsion?

Answer 6

• Sudden onset of testicular or scrotal pain (can awaken the patient at night
• pain is constant unless the testicle is intermittently detorsing
• vomiting
• scrotal edema
• tenderness
• elevation (due to cord shortening)
• absent cremasteric reflex
• horizontally lying testis

Question 7

What is a normal cremasteric reflex?

Answer 7

• Upon scratching the upper, medial thigh, the ipsilateral testis elevates (absent before 30 months of age and typically unreliable in patients older than 12 years of age)

Question 8

How is testicular torsion diagnosed?

Answer 8

Can be diagnosed clinically or by Doppler ultrasound (will show decreased testicular flow) or a nuclear scan of the scrotum (if the diagnosis is still uncertain)

Question 9

How is testicular torsion treated?

Answer 9

Urgent consultation with urology, surgical detorsion and orchiopexy of both testes

Question 10

What percentage of testes are viable after 12 hours of torsion?

Answer 10

20% (0% is viable after 24 hrs)