Testicular Torsion Flashcards
What is testicular torsion?
When the spermatic cord supplying a testicle twists
Cutting off the blood supply to the testicle
Can lead to testicle death, so it is treated as a medical emergency
At what age are males most affected with testicular torsion?
Most common in ages 11-30
Rare in the over 30s
What is the spermatic cord?
A cord containing:
- vas deferens
- lymphatic vessels
- blood vessels (veins + arteries)
- nerves
That supplies a testicle
What are the risk factors for testicular torsion?
Large testicle: due to a tumour or just naturally
Sudden temperature change from hot to cold
Undescended testis
Bell-clapper deformity
Why does a sudden change from hot to cold temperature sometimes cause testicular torsion?
Because the scrotum suddenly contracts trapping the testicle in a twisted position
What is bell-clapper deformity?
Where the testicle has formed with no attachment to its surrounding scrotal walls
It is free floating within the tunica vaginalis
What is the differential diagnosis of symptoms that look like testicular torsion?
Epididymitis
Epididymo-orchitis
Scrotal oedema
Incarcerated inguinal hernia
How can you distinguish between testicular torsion and epididymo-orchitis?
Epididymo-orchitis:
- presents less suddenly
- also symptoms of UTI
- no decrease in blood flow on Doppler USS
Clinical features of testicular torsion?
Acute onset of severe diffuse pain:
- in scrotum
- groin
- inguinal region
Testicular tenderness, swelling, warmth
Fever
Nausea
Vomiting
Investigations of testicular torsion?
Doppler ultrasound: looks at blood flow, will show if there is reduced blood flow to the testis
Decreased or absent cremasteric reflex
Surgical exploration is MANDATORY unless torsion can be excluded
What do you need to do if you suspect testicular torsion?
Surgical exploration, don’t delay!
Management of testicular torsion?
Urgent surgical intervention: untwist the testicle
If testicle is ischaemia or damaged remove it
What it is it important to do during surgery?
Fix both testes to the scrotum, to prevent future torsion
Why is time of the essence with testicular torsion?
The longer you delay, the more the chance of saving the testicle diminishes
