Testicular Torsion

Question 1

What is testicular torsion?

Answer 1

the lateral to medical inward twisting of the spermatic cord resulting in strangulation of the blood supply to the testes and the epididymis

Question 2

True or false: testicular torsion is a time sensitive urological emergency

Answer 2

True

Question 3

In what age group is testicular torsion at its peak incidence?

Answer 3

13-15 years

Question 4

Give 4 presentations associated with testicular torsion:

Answer 4

1) sudden onset hemi-scrotal pain
2) pain radiating to the groin, loin or epigastrium
3) nausea and vomiting
4) altered, broad-based ‘cowboy’ gait

Question 5

What testicular reflex is absent in testicular torsion patients?

Answer 5

cremasteric reflex

Question 6

Describe the cremasteric reflex:

Answer 6

lightly stroking the inner thigh pulls the testes up ipsilaterally

Question 7

Give 3 findings on testicular examination that would be associated with testicular torsion:

Answer 7

1) absent cremasteric reflex
2) high-riding testicles
3) swollen and very tender testicles

Question 8

What investigations are used to diagnose testicular torsion?

Answer 8

none - diagnosis is usually based on clinical presentation alone as scans are too time consuming for this urological emergency

Question 9

What is the treatment used for testicular torsion if the affected testicle is found to be viable?

Answer 9

de-torsion and orchidopexy

Question 10

What is orchidopexy?

Answer 10

a surgical procedure to fix the testicle to prevent recurrent torsion

Question 11

What treatment is used for testicular torsion if the affected testicle is found to be not viable (permanent ischaemic damage)?

Answer 11

orchidectomy of affected testicle and orchidopexy of contralateral testicle

Question 12

what is the aetiology of testicular torsion?

Answer 12

lack of tissue around the testicle allowing it to freely rotate in the scrotum

Question 13

what increases the risk of lack of tissue around the testicle leading to testicular torsion?

Answer 13

• Bell-clapper deformity (testis is inadequately fixed to the scrotum)
• undescended testicle
• trauma
• prior intermittent torsion

Question 14

what is Prehn’s sign?

Answer 14

elevation of the testicle to assess if pain is relieved or persists

Question 15

what are the complications of testicular torsion?

Answer 15

• testicular necrosis
• impaired fertility