Testicular Pain and Torsion Flashcards
What is Testicular Torsion?
- Twisting of spermatic cord resulting in testicular ischaemia and necrosis
What age group is testicular torsion most commonly seen in?
Ages 10-30
What is the clinical presentation of Testicular Torsion?
- Nausea and vomiting
- Severe lower abdominal pain of sudden onset
- Inflammation of testes
- Cremasteric reflex lost
What is the differential diagnosis of Testicular Torsion?
- Epididymo-orchitis (inflammation of epididymis)
- Tumour
- Trauma
- Acute Hydrocele
Epididymo-orchitis is the most common differential. With Epididymo-orchitis, the pain is usually relieved when the testes are raised, unlike torsion. Cremasteric reflex may be present with Epididymo-Orchitis, where as in torsion it is definitely absent
What are the investigations and management of Testicular Torsion?
- Scrotal exploration - reduces likelihood of irreversible damage, both testes should be fixed
- Doppler US - shows lack of blood flow to the testes
What are the different types of undescended testes?
=> Cryptochidism
- Complete absence of testes from scrotum
=> Retractile testes
- Excessive cremasteric reflex
=> Maldescended testes
- Testes found anywhere along the normal path they should have taken
=> Ectopic testes
Most commonly found at the superior inguinal pouch
What are the common complications of Maldescended or Ectopic testes?
- Infertility
- Increased risk of testicular cancer
- Increased risk of testicular trauma
- Increased risk of testicular torsion
- Hernias
What is the treatment of Maldescended and ectopic testes?
Surgery => Dartos pouch procedure
Hormonal => hCG
What is a hydrocele?
Accumulation of fluid within the tunica vaginalis
=> Can be categorised as:
- primary or secondary
- communicating or non-communicating
=> Hydroceles can occur secondary to:
- Epididymo-orchitis
- Testicular torsion
- Testicular tumours
What is the difference between a communicating and non-communicating hydrocele?
=> Communicating:
- Occur as a result of peritoneal fluid from the abdomen draining into the scrotum
=> Non-communicating:
- Occur as a result of excess fluid production within the tunica vaginalis
What are the clinical features of a hydrocele?
- Soft, non tender swelling
- Transilluminates with pen torch
- Testes difficult to palpate if hydrocele large
What are the investigations in suspected Hydrocele?
Ultrasound
What is the management of Hydrocele?
- Aspiration on surgery
Children hydroceles may have to be repaired if they do not resolve themselves by the ages of 1-2
What is a Varicocele?
Abnormal enlargement of testicular veins
Which side of the testes are most commonly affected by Varicoceles?
Left side
