Testicular torsion

Question 1

What is testicular torsion?

Answer 1

When the spermatic cord and its contents twists within the tunica vaginalis - compromising the blood supply to the testicle

Question 2

When is the most common age for torsion?

Answer 2

10-30 years with peak around 13-15.

Question 3

What are the risk factors for testicular torsion?

Answer 3

• Age (12-25)
• Previous torsion
• Family history
• Undecented testes
• Bell clapper deformity (testies lie horizontally)

Question 4

What are the signs and symptoms of torsion

Answer 4

• Severe, sudden onset of pain which may be referred to lower abdomen.
• Nausea and vomiting,
• Swollen testies retracted upwards.
• Lost cremaster reflex
• Negative Prehn’s test

Question 5

What are the investigations of torsion?

Answer 5

• Clinical diagnosis so straight to theater for scrotal exploration.
• If unsure then doppler ultrasound
• Urinalysis to rule out infection

Question 6

WHat is the management of torison?

Answer 6

Surgical emergency so must be rushed to theater especially in first 4 hours of onset or else ischaemic damage or atrophy occurs. Urgent surgical exploration - where they will untwist testies and fix them to scrotum (bilateral orchidopexy)

Question 7

What are the complications of torsion?

Answer 7

Testicular infarction (if left over 8 hours) and infertility, atrophy, chronic pain, future torsion

Question 8

What are the differential diagnosis for testicular torsion?

Answer 8

• Epididymo-orchtiis,
• Hydrocele or varicoele,
• testicular cancer
• Isolated orchitis
• Fournier’s gangrene

Question 9

What is Fournier’s gangrene?

Answer 9

• Necrotising fascitis of the perineal and genital region. It is type 1 so is polymicrobial