Testicular Torsion Flashcards
What is testicular torsion?
Spermatic cord and its contents twists within the tunica vaginalis, compromising the blood supply to the testicle. It is a surgical emergency, as without treatment the affected testicle will infarct within hours. Peak age between 12-25 yrs old.
What is the pathophysiology of testicular torsion?
Mobile testis rotates on the spermatic cord. Leads to reduced arterial blood flow, impaired venous return, venous congestion and resulant oedema and infarction of the testis if not corrected.
What is an anatomical variant that increase chance of testicular torsion?
Horizontal lie to their testis. Often term ‘bell-clapper deformity’. Lacks normal attachment to tunica vaginalis and therefore more mobile and increasing likelihood of twisting.
What is neonatal testicular torsion?
Neonates attachment between the scrotum and tunica vaginalis is not fully formed and the entire testis and tunica vaganalis can tort. ‘Extra-vaginal torsion’.
Can also occur in-uetro so must be checkedat birth. ‘Intra-vaginal’
What are the risk factors for testicular torsion?
Age - 12-25
Previous testicular torsion
Family history of testicular torsion
Undescended testes
What are the clinical features of testicular torsion?
Sudden onset severe unilateral testicular pain. Often associated with N/V. Reffered abdominal pain.
Examination - testis in high position with horizontal lie. Swollen and extremely tender.
Cremasteric reflex absent and negative Prehns sign.
What are the differential diagnosis for testicular torsion?
Epididymo-orchitis
Other:
Trauma, incarcerated ingunial hernia, testicular cancer, renal colic, hydrocele, idiopathic scrotal odema and torsion of the hydatid of Morgagni.
What is the torsion of the hydatid of Morgagni?
hydatid of Morgagni is a remnant of the mullerian duct and is a common testicular appendage. Structure can also become torted, presnting with similar sudden onset pain. More common in younger age group and scrotum is less erythematous with a normal lie of the testis.
Blue sot sign may be presnt in upper half of the hemiscrotum, which is the visible infarcted hydatid.
What investigations may be ordered for testicular torsion?
Usually clinical diagnosis and requires urgent scrotal exploraton.
But if unclear the doppler ultrasound can be performed. And urine dipstick.
What is the management of testicular torsion?
Surgical managemnt with 4-6 hrs since onset of symptoms before significant ischaemia occurs.
Analgesia and anti-emtics + NBM before surgery. Urgent surgical exploration.
If confirmed the bilataral orchidopexy perfoemed (testicles untwised and fixed to scrotum)
If testis not viable then orchidectomy may be warrented +/- prosthesis at time of surgery or later date.
What are the complications of testicular torsion?
Testicular infarction
Despite treatment - testicular atrophy may occur
Chronic pain, palpable suture, risk to future fertility and theoretical risk of future torsion.
