Scrotal Disease: Testicular Torsion Flashcards
Defintion
Spermatic cord twists itself = occlusion of testicular artery = leads to ischaemia and gangrene of the testis if not dealt with.
- germ cells most susceptible to ischaemia
- prompt surgery < 6 hours, the salvage rate is 90-100%
- if performed > 24 = 0-10%
Epidemiology
Young boys
Men (13 - 15 years old)
Risk factors
Young age
Bell clapper deformity - “horizontal lie” of testes
Cryptorchidism (undescended testis)
Trauma
Pathophysiology
Twisting the blood vessels can lead to ischaemia + necrosis of the testicles leading to infertility
Signs
Rotation = epididymis is not normal posterior position
Testicle swollen + red
Absent cremasteric reflex and pain not relieved by elevating testis
Prehns negative - pain is not lifted by Ipsilateral testicle (unlike epididymitis)
Testicle may be retracted/elevated
Symptoms
Any male child presenting with abdominal pain should have their testis examined
Pain esp. during activity * HURTS TO WALK *
Acute severe, unilateral testicular pain
Abdo pain, Nausea + vomiting
Diagnosis
If physical exam suggests TT, DO NOT do imaging as it delays surgery + prolongs ischaemia
FIRST LINE = Surgical exploration
- should be performed within first 6 hours
Testicular USS: Whirl pool sign (spiral appearance to the spermatic cord + blood vessels) suggests torsion.
Also decreased blood flow in affected testicle
Urinalysis: Presence of leukocytes may suggest something else (e.g epididymitis - orchiditis)
DDx
Epididymitis
Hydrocele
Varicocele
Testicular cancer
Inguinal hernia
Management
Viable testicle = Bilateral orchidopexy - testicle untwisted + fixed to scrotal sac
Non-viable: Ipsilateral orchiectomy + contralateral orchiopexy
If surgery delayed: manual detorsion
Complications
Recurrent torsion
Infertility
Puberty delay if bilateral orchidectomy is performed hormonal replacement required
