Testicular Torsion Flashcards
What is testicular torsion?
It is defined as a urological emergency in which there is twisting of the spermatic cord within the scrotum
What is the pathophysiological consequence of testicular torsion?
It leads to occlusion of testicular venous return, ultimately resulting in ischaemia and necrosis
What eight risk factors are associated with testicular torsion?
Young Age, 10 – 30 Years Old
Pubertal Changes
Family History
Previous Testicular Torsion
Cryptorchidism
Bell-Clapper Deformity
Testicular Cancer
Strenuous Exercise
What are the eight clinical features of testicular torsion?
Severe Unilateral Testicular Pain
Unilateral Swollen Testis
Erythematous Scrotal Skin
Testicular Retraction
Cremasteric Reflex Loss
Negative Prehn’s Sign
Lower Abdomen Pain
Nausea & Vomiting
What is the cremasteric reflex?
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
What is Prehn’s sign?
It describes elevation of the testis in order to releviate testicular pain
In neonates, how does testicular torsion tend to present?
Asymptomatically
On clinical examination, there is a firm, hard and enlarged testis in a blue scrotum
What investigation is used to diagnose testicular torsion?
Doppler Ultrasound Scan
What is the feature of testicular torsion on doppler ultrasound scans?
A lack of blood to the testis
When are doppler ultrasound scans contraindicated?
When surgical management would be delayed
What is the conservative management option of testicular torsion?
Manual Detorsion
When is manual detorsion used to manage testicular torsion?
When individuals present early or whilst waiting for surgical exploration
What is manual detorsion?
It involves manually rotating the affected testicle from the medial to the lateral position
What should be conducted when manual detorsion is successful? Why?
Surgical exploration
This is due to the fact that it is a temporary measure
What is the surgical management option of testicular torsion?
Urgent Surgical Exploration
What is the gold standard management option of testicular torsion?
Urgent Surgical Exploration
What is surgical exploration?
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
When is bilateral orchidopexy used to manage testicular torsion?
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
What is bilateral orchidopexy?
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
When is unilateral orchidectomy used to manage testicular torsion?
When the testis has a black tinge and looks unviable – which usually occurs when individuals present after 6 hours of clinical feature onset
What is orchidectomy?
It involves removal of the testis
Why is urgent surgical fixation still recommended when clinical features subside?
This is due to the high risk of immediate retorsion
What are the three complications associated with testicular torsion?
Testis Necrosis
Testicular Infection
Subfertility
What condition does testicular torsion present similarly to?
Epididymitis
How do we differentiate between testicular torsion and epididymitis?
Testicular torsion = negative Prehn’s sign
Epididymitis = positive Prehn’s sign
