Testicular torsion Flashcards

1
Q

What is testicular torsion?

A

spermatic cord twists within the tunica vaginalis, compromising the blood supply

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2
Q

Is testicular torsion an emergency and why?

A

Yes because without treatment the testicle will infarct within a few hours

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3
Q

How does testicular occur?

A

Mobile testes rotate on the spermatic cord, this causes reduced arterial blood flow, impaired venous return and venous congestion, which leads to oedema and infarction to the testis

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4
Q

What deformity makes men more prone to testicular torsion?

A

Bell clapper deformity- a horizontal lie, and lack a normal attachment to the tunica vaginalis and so is more mobile and prone to twisting on cord structures

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5
Q

Why are neonates likely to get testicular torsion?

A

the attachment between the scrotum and tunica vaginalis is not fully formed and so the entire testis and tunica vaginalis can tort- extra vaginal torsion, t

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6
Q

What are the risk factors for testicular torsion?

A

age, previous testicular torsion, family history of testicular torsion and undescended testes

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7
Q

What are the clinical features of testicular torsion?

A

Sudden onset severe unilateral testicular pain with nausea and vomiting due to the pain, may have some abdominal pain

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8
Q

On examination of testicular torsion, where are the testis positioned and how will they be?

A

Higher compared to the other side with a horizontal lie, they will also be swollen and red

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9
Q

In testicular torsion what reflex is absent?

A

Cremesteric reflex

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10
Q

In testicular torsion will Prehns sign be positive or negative?

A

Negative- pain will not stop on elevation

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11
Q

What are the differential diagnosis for testicular torsion?

A

epididymo-orchitis, trauma, incarcerated inguinal hernia, malignancy, renal colic, hydrocoele, idiopathic scrotal oedema, torsion of hydride morgagni

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12
Q

What is torsion of the hydatid of Morgagni?

A

remnant of the mullerian duct, common testicular appendage that may become sorted and has similar sudden onset pain- may have a blue dot sign

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13
Q

How is testicular torsion diagnosed?

A

Clinical diagnosis, will explore the testis, can do a doppler ultrasound to investigate compromised blood flow, urine dipstick may be done to check for infective cause

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14
Q

What is the management for testicular torsion?

A

surgical emergency that has a 4-6hour window to salvage the testis before significant ischaemic damage occurs, analgesia and anti-emetics

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15
Q

What is the name for testicular torsion surgery?

A

Bilateral orchidopexy, unless non-viable in which case orchidectomy may be needed

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16
Q

What are the complications of testicular torsion?

A

testicular infarction and atrophy, chronic pain, future fertility issues, palpable suture, future torsion despite fixation