Testicular Torsion

Question 1

Define:

Answer 1

Twisting or torsion of the spermatic cord results initially in venous outflow obstruction which progresses to arterial occlusion and testicular infarction if not treated.

A surgical emergency

Question 2

Aetiology:

Answer 2

Intravaginal is the most common –> spermatic cord twists within the tunica vaginalis

Extravaginal - usually in neonates where the entire testis and the tunica vaginalis twist ina . a vertical axis around the spermatic cord.

Question 3

Risk factors:

Answer 3

Imperfectly descended testes

High investment of tunica vaginalis

Question 4

Epidemiology:

Answer 4

Most common cause of acute scrotal pain in 10-18 year olds

Mostly occurs in 11-30 year old males

Question 5

Symptoms:

Answer 5

SUDDEN ONSET
Severe hemiscrotal pain 
Walking is uncomfortable 
Abdominal pain 
Nausea and vomiting

Question 6

Signs:

Answer 6

Swollen and erythematous scrotum on the affected side (tender, hot and swollen)

Affected side will be higher than unaffected one

Testicle may lie horizontal

Thickened cord

Testicular appendix

Question 7

What may also present similarly to testicular torsion?

Answer 7

Epididymo-orchitis - usually not as acute

Incarcerated inguinal herina

Question 8

Investigations:

Answer 8

Duplex imaging of the testes

DO NOT DELAY SURGERY

Arterial inflow (is it reduced in testicular torsion, will be increased in epididymo-orchitis)

Question 9

Management:

Answer 9

Exploration of the scrotum < 6hrs from the onset as this has a 90-100% salvage rate.

If >24hrs then the salvage rate is 0-10%

Bilateral Orchodopexy to stop recurrence by suturing the testicles to the scrotal tissues)

If the testicle is necrotic then may perform orchidectomy

Question 10

Complications:

Answer 10

Testicular infarction
Testicular atrophy
Infection
Impaired fertility

Question 11

Prognosis:

Answer 11

From onset testicle may be salvaged if surgical intervention in 4-6 hours.