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
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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
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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
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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
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5
Q

Symptoms of testicular torsion

A
  • Sudden onset
  • Severe unilateral testicular pain
  • N+V secondary to pain
  • Can get referred pain to abdomen
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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
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7
Q

Differentias for testicular pain

A
  • Epididymo-orchitis - more gradual, LUTS +/- pyrexia
  • Inguinal hernia
  • Testicular cancer
  • Renal colic
  • Torsion of hydatid of Morgagni
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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
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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
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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
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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
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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
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13
Q
A
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