Testicular Torsion

Question 1

What is testicular torsion?

Answer 1

It is defined as a urological emergency in which there is twisting of the spermatic cord within the scrotum

Question 2

What is the pathophysiological consequence of testicular torsion?

Answer 2

It leads to occlusion of testicular venous return, ultimately resulting in ischaemia and necrosis

Question 3

What eight risk factors are associated with testicular torsion?

Answer 3

Young Age, 10 – 30 Years Old

Pubertal Changes

Family History

Previous Testicular Torsion

Cryptorchidism

Bell-Clapper Deformity

Testicular Cancer

Strenuous Exercise

Question 4

What are the eight clinical features of testicular torsion?

Answer 4

Severe Unilateral Testicular Pain

Unilateral Swollen Testis

Erythematous Scrotal Skin

Testicular Retraction

Cremasteric Reflex Loss

Negative Prehn’s Sign

Lower Abdomen Pain

Nausea & Vomiting

Question 5

What is the cremasteric reflex?

Answer 5

It involves stroking of the inner thigh

This should causes an upward movement of the scrotal contents through stimulation of the L1/L2 spinal reflex

Question 6

What is Prehn’s sign?

Answer 6

It describes elevation of the testis in order to releviate testicular pain

Question 7

In neonates, how does testicular torsion tend to present?

Answer 7

Asymptomatically

On clinical examination, there is a firm, hard and enlarged testis in a blue scrotum

Question 8

What investigation is used to diagnose testicular torsion?

Answer 8

Doppler Ultrasound Scan

Question 9

What is the feature of testicular torsion on doppler ultrasound scans?

Answer 9

A lack of blood to the testis

Question 10

When are doppler ultrasound scans contraindicated?

Answer 10

When surgical management would be delayed

Question 11

What is the conservative management option of testicular torsion?

Answer 11

Manual Detorsion

Question 12

When is manual detorsion used to manage testicular torsion?

Answer 12

When individuals present early or whilst waiting for surgical exploration

Question 13

What is manual detorsion?

Answer 13

It involves manually rotating the affected testicle from the medial to the lateral position

Question 14

What should be conducted when manual detorsion is successful? Why?

Answer 14

Surgical exploration

This is due to the fact that it is a temporary measure

Question 15

What is the surgical management option of testicular torsion?

Answer 15

Urgent Surgical Exploration

Question 16

What is the gold standard management option of testicular torsion?

Answer 16

Urgent Surgical Exploration

Question 17

What is surgical exploration?

Answer 17

It involves an incision of the scrotum and removal of the testes from the scrotal sac

The testis is de-torted and its colour is observed, in order to determine whether bilateral orchidopexy or unilateral orchidectomy should be conducted

Question 18

When is bilateral orchidopexy used to manage testicular torsion?

Answer 18

When the testis has a red tinge and looks viable – which usually occurs when individuals present within 6 hours of clinical feature onset

When individulas present with intermittent testicular torsion

Question 19

What is bilateral orchidopexy?

Answer 19

It involves bilateral fixation of the testis, in which it is sutured to the tunica vaginalis and returned to the scrotum in its correct orientation

Question 20

When is unilateral orchidectomy used to manage testicular torsion?

Answer 20

When the testis has a black tinge and looks unviable – which usually occurs when individuals present after 6 hours of clinical feature onset

Question 21

What is orchidectomy?

Answer 21

It involves removal of the testis

Question 22

Why is urgent surgical fixation still recommended when clinical features subside?

Answer 22

This is due to the high risk of immediate retorsion

Question 23

What are the three complications associated with testicular torsion?

Answer 23

Testis Necrosis

Testicular Infection

Subfertility

Question 24

What condition does testicular torsion present similarly to?

Answer 24

Epididymitis

Question 25

How do we differentiate between testicular torsion and epididymitis?

Answer 25

Testicular torsion = negative Prehn’s sign

Epididymitis = positive Prehn’s sign