Testicular torsion Flashcards
Define Testicular torsion
Testicular torsion occurs when the spermatic cord and its contents twists within the tunica vaginalis
Testicular torsion complication
Testicular ischaemia and necrosis
Testicular torsion Sx
- Acute, onset unilateral testicular pain
- Abdo pain
- Nausea + Vomiting
Testucular torsion examination findings
- Firm + swollen testicule
- Retracted/elevated testicle
- Absent cremasteric reflex
- Abnormal lie (horizontal) testicle
- Rotation of the epididimis
Testicular torsion Mx
Urological emergency
- Nil by mouth
- Analgesia
- Urgent urology assessment
- Surgical exploration
2 Testicular torsion surgical options
- Orchiopexy - correction and fixation of the testicle
- Orchidectomy - removal of the testicle
what imaging can be used in Dx teticular torsion
Scrotum USS
Scrotum USS findings
whirpool sign (spiral appearance of the spermatic cord and vessel)
why is scrotum USS not commonly used in testicular torsion
can delay theatre operation
surgical correction/fixation
Orchiopexy indication
viable testis upon exploration
Surgical removal
Orchiodectomy indication
non-viable testis - necrosis
what is the time frame of saving a testicle from the onset of testicular torsion Sx
within 6 hours
what is ‘bell-clapper deformity’
horizontal lie to the testes - lacks normal attachment of the tunica vaginalis –> twisting on cords
Testicular torsion risk factors
- Age 12 - 25yrs
- Previous testicular torsion
- FHx testicular torsion
- Undescended testes
what is ‘The TWIST Score’
Testicular Workup for Ischemia and Suspected Torsion - assesses the likelihood of testicular torsion
what is ‘The TWIST Score’ used for
Differentiate between patients who require
- immediate scrotal (surgical) exploration
OR
- Scrotum USS.
How to perform a ‘cresmateric reflex’
- Pt lie supine
- identify medial-upper thigh
- stroke in a downward direction
- Testis should elevates
