Testicular Pathology; Torsion Flashcards
What is testicular torsion?
Testicular torsion is a urological emergency characterized by the twisting of the testicle around the spermatic cord due to inadequate attachment of tissues within the scrotum. This situation leads to the obstruction of blood flow to the affected testicle, which if not promptly treated, can result in testicular necrosis
What is the presentation of testicular torsion?
Most common in enonates and 13-16 year olds
Sudden onset, severe pain in one testicle
The event often follows minor trauma
What are the visual features of testicular torsion?
Unilateral loss of cremaster reflex
Persistent pain despite the elevation of the testicle (negative Prehn’s sign)
Nausea and vomiting due to pain
How can testicular torsion present in neonates/
painless scrotal swelling which does not transilluminate.
What is negative Prehn’s sign?
Persistent pain despite the elevation of the testicle, indicating testicular torsion
What is the key diagnostic test for testicular torsion?
Doppler ultrasound showing Whipple spoon of spermatic cord, demonstrating reduced blood flow.
Other test includes urinalysis
What is the management of testicular torsion?
Urgent surgical exploration: This is crucial to confirm the diagnosis and to attempt to salvage the testicle.
Bilateral orchidopexy: Fixation of both testicles is performed to prevent future torsion.
How is testicular torsion managed in neonates?
Torted testis is removed and the contralateral testis is fixed in place
What causes gradual onset unilateral pain and swelling of testes?
Epididymo-orchtis
What is epididymo-orchitis?
Inflammation of epididymis and testicular, common in sexually active makes and assoicated with STIs
What is the cause of epididymo-orchitis?
STI and chlamydia is most common cause
Gonorrhoeal and UTI
What are the symptoms of epididymo-orchitis?
Testicular swelling and tenderness
Fever
Dye,suria
Urethral discharge
How is epididymo-orchitis diagnosed?
-> Urinalysis
-> NAAT test for STI
-> Urethra swab and gram stain
-> Scrotal ultrasound
What is the management of epididymo-orchit is?
Antibiotics for STI ceftriazone with IM injection
Analgesics for pain relief
What causes loss of the cremasteric reflex?
Testicular torsion
What causes pain in renal colic pain?
Colicky loin to groin
What is hydrocele?
Fluid collection around the testicular, from incomplete obliteration of the processus vaginalis during normal testicular descent.
What is a secondary cause of hydroceles?
Occur when there is excessive fluid produced within tunica vaginalis. Often secondary to malignancy, trauma or infection
What is the symptoms of hydrocele?
Scrotal swelling
Discomfort
Pain and redness
Diagnoses s clinical but ultrasound can confirm fluid.
What is the management of hydrocele?
Surgical correction and typically resolves in first year of life
What causes bag of worms feeling in the scrotum?
Varciocele, which is an abnormal enlargement of the venous plexu in the scrotum.
Investigatio is ultrasound
What should be suspected with left-sided varicocelel?
Renal cell carcinoma due to left testicular vein taking venous return from left renal vein
Hw is hydroceles managed?
Most spontaneously resolve at 12 months
