Surgery

Question 1

What is Testicular Torsion?

Answer 1

• Surgical emergency
• Twisting of spermatic cord resulting in constriction of vascular supply and ischaemia of testicular tissue
• Intravaginal : twisting within tunica vaginalis (most common cause of acute scrotal pain in 10-18yo)

Extravaginal : entire testis and tunica vaginalis twists (happens in neonates)

Question 2

RF for Testicular Torsion

Answer 2

• Age under 25
• Bell clapper deformity
  • allows testicles to rotate freely within tunica vaginalis
  • accounts for most cases of intravaginal torsion

Question 3

H&E for Testicular Torsion

Answer 3

• Pain
• Swelling
• Unilateral
• High-riding testicle
• Absent cremasteric reflex
• Negative Prehn’s sign (elevation of affected testis does not relieve pain)

Question 4

Investigations for Testicular Torsion

Answer 4

Doppler USS will show whirlpool sign

Question 5

Management of Testicular Torsion

Answer 5

WITHIN 6 HOURS OF SYMPTOM ONSET, DO NOT DELAY FOR DOPPLER USS

• Emergency exploration of scrotum + bilateral orchidopexy

Manual de-torsion if surgery not available in 6 hours