Testicular Torsion

Question 1

What happens in testicular torsion?

Why is it a urological emergency?

Answer 1

Twisting of spermatic cord with rotation of the testes

Delaying treatment can lead to ischaemia and necrosis of testicle -> can lead to subfertility and infertility

Question 2

How might someone with testicular torsion present?

Answer 2

Typically a teenage boy

Hx of player sports or doing an activity when it occured

Acute rapid onset of unilateral testicular pain

Abdo pain-> can be only presentation for some

Vomiting

Question 3

What would you expect to find on examination?

How can you confirm the diagnosis? Would you also do this investigation?

Answer 3

Firm swollen testicle

Elevated/retracted testicle

Absent cremasteric reflex (stroking of inner thigh causing cremaster muscle to contract and retract testes)

Abnormal testicular lie-> might be horizontal

Rotated-> epididymus won’t be posterior

Scrotal USS
-whirlpool sign= spiral appearance to spermatic cord +BV
Only do if not going to delay patient from getting surgery

Question 4

What is a bell-clapper deformity and why can it cause testicular torsion?

Answer 4

Lack of fixation between the testicle and tunica vaginalis meaning that the testicle hangs in horizontal position rather than verticle

Leads to testicle being able to rotate within the tunica vaginalis and twisting the spermatic cord cutting of the blood supply

Question 5

How would you manage testicular torsion?

Answer 5

NBM
Analgesia 
Urgent senior review 
Surgical exploration of scrotum 
Orchiopexy= corrects the positions of testicles and fixes them in place 
Orchidectomy of necrosis present