Testicular Torsion Flashcards
What is testicular torsion?
When a testicle rotates, twisting the spermatic cord that brings blood to the scortum
What occurs as a result of twisting of the spermatic cord?
Reduced blood flow causing sudden and often severe pain and swelling
In what age group is testicular torsion most common?
Post-pubertal boys
Is testicular torsion limited to post pubertal boys?
No, it can occur at any age including newborns
What are the two types of testicular torsion?
- Intravaginal
- Extravaginal
What is intravaginal testicular torsion?
When the torsion occurs within the tunica vaginalis
What is extravaginal testicular torsion?
When the torsion occurs outside the tunica vaginalis
Almost all torsion events in older boys are of which type?
Intravaginal
In which age group are extravaginal torsions commonly seen?
Perinatal cases
What forms the basis of all torsion events?
Twisting of the spermatic cord
When does ischaemia occur in testicular torsion?
When the twist is sufficient to obstruct arterial inflow
What can testicular ischaemia result in?
Infarction
What do lesser degrees of torsion often result in?
Obstruction of venous outflow?
What can venous outflow obstruction lead to?
Congestion and swelling of the testis
What is the main risk factor of intravaginal torsion?
Bell clapper deformity
What is a bell clapper deformity?
Where the testis lie horizontally within the tunica vaginalis and lack posterior anchoring
What are the risk factors for extravaginal torsion?
- Large birth weight
- Difficult labour
- Breech presentation
- Overreactive cremasteric reflex
How may testicular torsion present?
- Acute onset pain
- Redness and oedema of scrotal skin
- N & V
- Abnormal teste position
- Absent cremasteric reflex
Where may the pain localise in testicular torsion?
Groin or lower abdomen
How may the testes be abnormally positioned in testicular torsion?
May be high riding and/or transversely oriented
What test is diagnostic of testicular torsion?
Doppler ultrasound
What result is seen on doppler ultrasound in torsion?
Absent Doppler signal in testicular parenchyma
What is absent Doppler signal indicative of?
Lack of blood supply
What test may be useful to rule out infective causes of testicular pain?
Urinalysis
If acute torsion is suspected what should not be delayed?
Treatment
What are some differentials for torsion?
- Incarcerated hernia
- Epididymitis
- Henoch-Schonlein Purpura
- Orchitis
- Hydrocoele
What conservative management technique is used in some cases?
Manual detorsion
What does manual detorsion involve?
Untwisting the spermatic cord by manipulating the testis so the anterior surface rotates from medial to lateral
What is manual detorsion mostly used for?
Buying time before surgical intervention
Why is manual detorsion rarely used?
It is difficult
What are the goals of surgery?
- Confirmation of diagnosis
- Assessment
- Detorsion
- (Removal of involved testis if necessary)
- (Fixation of involved testis to prevent recurrence if appropriate)
If torsion occurs in one of the testis what may be appropriate in terms of the other?
Fixation to prevent torsion in the future
What is the main complication of testicular torsion?
Necrosis and loss of testicle
What may occur as a result of removal of testicle(s)
Reduced fertility
