Testicular Torsion

Question 1

What is Testicular Torsion?

Answer 1

A urological emergency where there is twisting of the spermatic cord with rotation of the testicle.

Question 2

Clinical Features of Testicular Torsion (4).

Answer 2

1. Acute Onset of Unilateral Testicular Pain.
2. Triggered by Activity e.g. Sports.
3. Referred Lower Abdominal Pain.
4. Nausea and Vomiting.

Question 3

Epidemiology of Testicular Torsion.

Answer 3

Commonest in males between 10 and 30 : Peak 13-15.

Question 4

Examination Findings of Testicular Torsion (4).

Answer 4

1. Swollen Tender Firm Testis Retracted Upwards.
2. Absent Cremasteric Reflex.
3. Abnormal Testicular Lie - Elevated and Rotated so Epididymis is not posterior.
4. Prehn’s Sign Negative - Elevation of the testis does not ease the pain.

Question 5

Deformity Aetiology.

Answer 5

Bell Clapper :
Testicle is usually fixed posterior to the Tunica Vaginalis. In the deformity, fixation between the testis and tunica vaginalis is absent so the testis hangs in a horizontal position so it can rotate.

Question 6

Investigation of Testicular Torsion (2).

Answer 6

1. Do not investigate - main.

2. Doppler US Scrotal - Whirlpool Sign (Spiral Appearance of Spermatic Cord and Vessels).

Question 7

Management of Testicular Torsion (4).

Answer 7

1. 6 Hour Window - Pain–> Irreversible Ischaemia.
2. Immediate Surgical Scrotal Exploration.
3. Orchiopexy (Correction and Fixation in Place).
4. Orchidectomy (if delayed or necrosis).

Question 8

Deformity Management.

Answer 8

If a torted testis is identified, then both testes should be fixed since Bell-Clapper is bilateral often.

Question 9

Main Complication of Testicular Torsion.

Answer 9

Subfertility/Infertility - ischaemia and necrosis of the testicle.