Testicular Torsion (1) Flashcards
What occurs here?
What is the clinical significance of this? What needs to be done and how soon?
➊ Twisting of the spermatic cord
➋ Urological emergency - Delay in treatment increases the risk of ischaemia and necrosis, which leads to decreased fertility or infertility
• If surgery done < 6hrs, salvage rate = 90-100%
• If surgery done > 24hrs, salvage rate = 0-10%
How does it present?
What often triggers it?
What is found O/E?
How is it differentiated from acute epididymitis?
What are the differentials?
➊ Sudden unilateral testicular pain - may be associated with abdominal pain and vomiting
➋ Activity, such as sports - Important to ask what the pt was doing when the pain started
➌ • Firm, swollen, warm testicle
• Elevated/Retracted testicle that may lie horizontally
• Absent cremasteric reflex
➍ Negative Phren’s sign
• Elevation of the testicle will relieve pain in acute epididymitis, but won’t in torsion
➎ • Acute epididymitis
• Epididymo-orchitis
• Trauma, Tumour, Hydrocoele
How is it investigated?
How is it managed?
➊ Immediate surgical exploration
➋ • Analgesia
• Orchiopexy - correcting position of testicle and fixing it into place
• Orchidectomy - removal of testicle if surgery delayed or necrotic
