Testicular torsion Flashcards
1
Q
Pathophys of testicular torsion
A
- Mobile testes rotates on spermatic cord
- = reduced arterial flow, impaired venous return, venous congestion, oedema and then infarction of testes if not corrected
2
Q
What is ‘bell clapper’ deformity?
A
- Anatomical variant
- Testis dont have a normal attachment to tunica vaginalis, tunica vaginalis attaches high
- Therefore more mobile so more risk of twisting
3
Q
What is neonatal testicular torsion?
A
- Attachment between scrotum and tunica vaginalis is not fully formed
- Entire testes and tunica vaginalis can twist = extra-vaginal torsion
- Can occur in utero and new borns need to be examined
- All other torsions are intra-vaginal with the freely moving cord and testes torting within vaginalis
4
Q
RF for testicular torsion
A
- Age - 12-25 most common
- Previous torsion (previous non specific testicular pain that self resolved could be this)
- FH of testicular torsion
- Undescended testes
5
Q
Symptoms of testicular torsion
A
- Sudden onset
- Severe unilateral testicular pain
- N+V secondary to pain
- Can get referred pain to abdomen
6
Q
Examination findings for testicular torsion
A
- High position testis - compared to contralateral side
- Horizontal lie
- Swollen
- Tender
- Cremasteric reflex absent
- Prehns sign negative
7
Q
Differentias for testicular pain
A
- Epididymo-orchitis - more gradual, LUTS +/- pyrexia
- Inguinal hernia
- Testicular cancer
- Renal colic
- Torsion of hydatid of Morgagni
8
Q
What is hydatid of morgagni?
A
- Remnant of Mullerian duct
- Common testicular appendage
- Can become torted - similar onset pain to testicular torsion
- Blue dot sign may be present - infarcted hydatid
9
Q
Investigations testicular torsion
A
- Clinical diagnosis - straight to theatre for scrotal exploration
- If uncertain if scrotal exploration will be beneficial - Doppler USS can investigate compromised blood flow
- Urine dip can assess for infection - rule out differentials
10
Q
Management testicular torsion
A
- Urgent surgical exploration of testes - surgical emergency
- Untwist and bilateral orchidopexy - fix testes to scrotum
- If non-viable testis - orchidectomy, prosthesis inserted at the time or later date
11
Q
Complications testicular torsion
A
- Infarction
- Affected testes –> atrophy after treatment
- Post surgery - chronic pain, palpable suture, risk to fertility, future torsion despite fixation
12
Q
Time to fix torsion
A
- Rates for salvage are good if surgery done within 6hrs of pain onset
- Drop to 50% if present symptoms for more than 12 hrs
13
Q
A