Testicular Torsion Flashcards

1
Q

What is testicular torsion?

A

When a testicle rotates, twisting the spermatic cord that brings blood to the scortum

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2
Q

What occurs as a result of twisting of the spermatic cord?

A

Reduced blood flow causing sudden and often severe pain and swelling

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3
Q

In what age group is testicular torsion most common?

A

Post-pubertal boys

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4
Q

Is testicular torsion limited to post pubertal boys?

A

No, it can occur at any age including newborns

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5
Q

What are the two types of testicular torsion?

A
  • Intravaginal

- Extravaginal

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6
Q

What is intravaginal testicular torsion?

A

When the torsion occurs within the tunica vaginalis

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7
Q

What is extravaginal testicular torsion?

A

When the torsion occurs outside the tunica vaginalis

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8
Q

Almost all torsion events in older boys are of which type?

A

Intravaginal

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9
Q

In which age group are extravaginal torsions commonly seen?

A

Perinatal cases

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10
Q

What forms the basis of all torsion events?

A

Twisting of the spermatic cord

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11
Q

When does ischaemia occur in testicular torsion?

A

When the twist is sufficient to obstruct arterial inflow

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12
Q

What can testicular ischaemia result in?

A

Infarction

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13
Q

What do lesser degrees of torsion often result in?

A

Obstruction of venous outflow?

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14
Q

What can venous outflow obstruction lead to?

A

Congestion and swelling of the testis

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15
Q

What is the main risk factor of intravaginal torsion?

A

Bell clapper deformity

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16
Q

What is a bell clapper deformity?

A

Where the testis lie horizontally within the tunica vaginalis and lack posterior anchoring

17
Q

What are the risk factors for extravaginal torsion?

A
  • Large birth weight
  • Difficult labour
  • Breech presentation
  • Overreactive cremasteric reflex
18
Q

How may testicular torsion present?

A
  • Acute onset pain
  • Redness and oedema of scrotal skin
  • N & V
  • Abnormal teste position
  • Absent cremasteric reflex
19
Q

Where may the pain localise in testicular torsion?

A

Groin or lower abdomen

20
Q

How may the testes be abnormally positioned in testicular torsion?

A

May be high riding and/or transversely oriented

21
Q

What test is diagnostic of testicular torsion?

A

Doppler ultrasound

22
Q

What result is seen on doppler ultrasound in torsion?

A

Absent Doppler signal in testicular parenchyma

23
Q

What is absent Doppler signal indicative of?

A

Lack of blood supply

24
Q

What test may be useful to rule out infective causes of testicular pain?

A

Urinalysis

25
If acute torsion is suspected what should not be delayed?
Treatment
26
What are some differentials for torsion?
- Incarcerated hernia - Epididymitis - Henoch-Schonlein Purpura - Orchitis - Hydrocoele
27
What conservative management technique is used in some cases?
Manual detorsion
28
What does manual detorsion involve?
Untwisting the spermatic cord by manipulating the testis so the anterior surface rotates from medial to lateral
29
What is manual detorsion mostly used for?
Buying time before surgical intervention
30
Why is manual detorsion rarely used?
It is difficult
31
What are the goals of surgery?
- Confirmation of diagnosis - Assessment - Detorsion - (Removal of involved testis if necessary) - (Fixation of involved testis to prevent recurrence if appropriate)
32
If torsion occurs in one of the testis what may be appropriate in terms of the other?
Fixation to prevent torsion in the future
33
What is the main complication of testicular torsion?
Necrosis and loss of testicle
34
What may occur as a result of removal of testicle(s)
Reduced fertility