Testicular torsion

Question 1

What is testicular torsion?

Answer 1

Twisting of the spermatic cord with rotation of the testicle. This can block the blood supply leading to ischaemia and necrosis if not treated urgently

Question 2

How does someone with testicular torsion present?

Answer 2

Acute rapid onset unilateral testicular pain.
Often triggered by activity such as sports.
Abdominal pain and vomiting

On examination

• firm, swollen testicle that is elevated and with an abnormal lie (horizontal)
• rotation
• absent cremasteric reflex

Question 3

What is the cremasteric reflex?

Answer 3

A reflex in males - when the inner part of the thigh is stroked, the cremaster muscle contacts and pulls the ipsilateral testicle up towards the inguinal canal.

Question 4

What are some risk factors for testicular torsion?

Answer 4

Bell clapper deformity
Age - most common in teenagers
Family history
Exercise and trauma

Question 5

What are some complications of testicular torsion?

Answer 5

Ischaemia and necrosis of the testicle

Reduced or infertility

Question 6

What is a bell clapper deformity?

Answer 6

Abnormality in the attachment of the testicle and the tunica vaginalis - means the testicle is not fixed in position. The testicle therefore lies more horizontally and is able to rotate within the tunica vaginalis.

Question 7

How is testicular torsion managed?

Answer 7

Emergency surgery

• orchiopexy - correcting position of the testicles and fixing them in place
• orchidectomy - removal if surgery is delayed and there is already necrosis