Testicular Torsion

Question 1

What is testicular torsion

Answer 1

Vascular disorder of testis due to rotation of testicle around spermatic cord
Can lead to testicular infarction
Urological emergency

Question 2

What does rotation of the testicle lead to?

Answer 2

Thick walled arteries remain open while thin walled veins obstructed > causes congestion > haemorrhagic infarction

Question 3

Risk factors

Answer 3

Young adolescent
Maybe in neonates and older indivudals
Usually due to testes’ congenital failure to storngly attach to scrotum
Trauma
During sleep

Question 4

Complications of testicular torsion

Answer 4

Untreated/ surgery delayed - testicle may not be salvageable > infertility
Recurrent torsions
Contralateral testicle
Infection
Orchiectomy > cosmetic malformattion > psychosocial problems

Question 5

Signs and symptoms of testicular torsion

Answer 5

Onset of acure, severe pain
Swollen, firm, tender erythematous scrotum
High riding testis - moves to higher scrotal position
Absent cremasteric reflex
Notender cord
Rotation
Epidydmis not in normal posterior position

Question 6

How to find diagnosis of testicular torsion

Answer 6

Diagnostic imaging - usually unnecessary
Color doppler ultrasound - absent or decreased blood flow in affected testicle
Contrast enhanced MRI - torsion knot or whirlpoor patterns - sensitive and specific
US - GS

Question 7

Treatment for testicular torsion

Answer 7

Surgery - immediate surgical detorsion - best within 6 hours from onset of symptoms - delay could lead to ischaemia and necrosis
Orchiopexy of testis to scrotum - if testicle non - salvageable - orchioectomy

Question 8

Bell-Clapper deformity

Answer 8

• One of the causes of testicular torsion
• Where the fixation between the testicle and the tunica vaginalis is absent
• Testicle hangs in a horizontal position (like a bell-clapper) instead of the typical more vertical position.
• Able to rotate within the tunica vaginalis, twisting at the spermatic cord. As it rotates, it twists the vessels and cuts off the blood supply.

Question 9

In what position is the testicle normaly fixed?

Answer 9

posteriorly to the tunica vaginalis

Question 10

Management of testicular torsion

Answer 10

Nil by mouth, in preparation for surgery
Analgesia as required
Urgent senior urology assessment
Surgical exploration of the scrotum
Orchiopexy (correcting the position of the testicles and fixing them in place)
Orchidectomy (removing the testicle) if the surgery is delayed or there is necrosis

Question 11

What can confirm a diagnosis of testicular torsion

Answer 11

scrotal ultrasound can confirm the diagnosis. However, any investigation that will delay the patient going to theatre for treatment is not recommended.

Ultrasound can show the whirlpool sign, a spiral appearance to the spermatic cord and blood vessels.