testicular torsion

Question 1

what is torsion?

Answer 1

twisting of the testicle on its spermatic cord, leading to ischaemia and eventually necrosis.

Question 2

what is the bell clapper abnormality?

Answer 2

high riding testicle with a horizontal lie

predisposes to testicular cancer

Failure of the tunica vaginalis to properly attach to the scrotum results in the ‘bell clapper’ abnormality

Question 3

what does a blue dot sign on the testicle suggest?

Answer 3

Hydatid of Morgagni, mimics testicular torsion

Torsion of this small bit of tissue can cause intense pain and characteristically causes a ‘blue-dot’ sign, but is often managed conservatively

Question 4

what are risk factors for torsion?

Answer 4

Young age: two peaks; one in the neonatal period and one around puberty, with a peak incidence of 13 to 15 years old

Bell clapper deformity: high riding testicle with a horizontal lie

Cryptorchidism: undescended testis increase the risk of torsion and would usually present in the first few months of life

Trauma: trauma-induced torsion accounts for less than 10% of cases

Question 5

why is surgical exploration the primary investigation for torsion if there is a high index of clinical suspicion?

Answer 5

Should be performed within 6 hours to prevent irreversible damage (90% salvageable at 6 hours and 10% salvageable at ≥24 hours)

Question 6

what sign will be present in testicular USS for testicular torsion?

Answer 6

whirlpool sign

Question 7

how would urinalysis rule out epididymoorchitis?

Answer 7

abnormal result such as the presence of leukocytes and nitrites may suggest an alternative diagnosis, e.g. epididymo-orchitis

Question 8

what are the different management options for testicular torsion?

Answer 8

viable testicle:
Bilateral orchiopexy: the affected testicle is untwisted and fixed to the scrotal sac. The contralateral testicle should always be fixed to prevent contralateral torsion

Non-viable testicle (e.g. necrotic):
Ipsilateral orchiectomy and contralateral orchiopexy: removal of the affected testis and fixation of the contralateral testis to the scrotal sac to prevent contralateral torsion

In cases of surgical delay:
Manual detorsion: a temporary measure that should only be performed if surgery is not available within 6 hours. Surgical exploration must be subsequently performed to ensure the viability of the testis