Testicular torsion

Question 1

What is testicular torsion

Answer 1

Twisting of the spermatic cord with rotation of the testicle. Urological emergency

Question 2

Testicular torsion presentation

Answer 2

Typically teenage boys
Acute rapid onset unilateral testicular pain, may have associated abdo pain and vomiting.
Firm swollen testicle
Elevated (retracted) testicle
Absent cremasteric reflex
Abnormal testicle lie (often horizontal)
Rotation, so that epididymis is not in normal posterior position

Question 3

Testicular torsion complications

Answer 3

Risk of ischaemia and necrosis of the testicles

Sub-fertility or infertility

Question 4

Causes of testicular torsion

Answer 4

Bell-clapper deformity
Testicles normally fixed posteriorly to the tunica vaginalis but fixation is absent in bell-clapper. Testicle hangs in a horizontal position instead of more vertical. Can rotate within tunica vaginalis, twisting at spermatic cord. Twists vessels and cuts off blood supply.

Question 5

Testicular torsion management

Answer 5

Nil by mouth in preparation for surgery
Scrotal ultrasound can confirm diagnosis - whirlpool sign to spermatic cord and blood vessels
Analgesia
Surgical orchiopexy (correct position of testicles and fix in place)
If necrosis orchidectomy (remove testicle)