TESTICULAR TORSION

Question 1

Testicular torsion requires emergent diagnosis for what end result

Answer 1

salvage the testicle.

Question 2

twist on the spermatic cord, potentially producing ischemia from reduced
arterial inflow and venous outflow obstruction.

Answer 2

Testicular torsion

Question 3

How do you get testicular torsion

Answer 3

Testicular torsion may occur after an inciting event (eg, trauma) or spontaneously.

Question 4

What’s the time frame for intervention to prevent the loss of the testis

Answer 4

6 hours

Question 5

What side is more likely to be involved in testicular torsion and why

Answer 5

More common on the left because of longer spermatic cord.

*usually rotates medially.

Question 6

Pertinent Anatomy of a patient with Testicular Torsion.

Answer 6

(1) Testicle

(2) Spermatic cord (vas deferens, cremasteric muscle, artery, vein, nerves)

Question 7

Signs and Symptoms

Answer 7

(1)Acute scrotal pain
(a) often occur several hours after vigorous physical activity or minor trauma to the
testicles
(2)Profound tenderness and swelling
(3)Nausea and vomiting
(4)Negative cremasteric reflex

(a) Due to impingement of cremasteric muscle and nerve
(5) Bell clapper deformity

(a) high-riding testis oriented transversely

Question 8

Differential Diagnosis

Answer 8

(1) Epididymitis
(2) Torsion of testicular appendage
(3) Incarcerated hernia
(4) Trauma
(5) Mumps

Question 9

Laboratory Findings

Answer 9

(1) None

(2) May consider UA to rule out infection

Question 10

Imaging

Answer 10

(1) Scrotal Ultrasound (with color flow Doppler)

(a) Absent or diminished blood flow in testicular torsion

Question 11

Treatment

Answer 11

(1)Manual detorsion (“opening a book”)
(a) Performed by grasping the testicle and rotating it within the scrotum outward (medial
to lateral) one to two full 360 degree turns.

(b) Prompt relief of pain, lower position of the testis in the scrotum, and return of arterial
flow on Doppler ultrasound suggests detorsion.

(c) If there is no improvement, try rotating the testicle in the opposite direction (lateral to
medial) because approximately one-third of torsed testicles may have lateral rotation.
(2) Surgical exploration and detorsion

(a) Regardless of result of manual detorsion

Question 12

Complications

Answer 12

(1)Orchiectomy

(a) Testicular salvage drops from 80-100% at 6-8 hours to nearly 0% by 12 hours.
(2) Testicular atrophy
(3) Infertility

(a) Due to abnormal spermatogenesis

Question 13

Follow up

Answer 13

(1) MEDEVAC

(2) As dictated by Urology