Testicular Torsion Flashcards
Define testicular torsion.
Testicular torsion is a urological emergency caused by the twisting of the testicle on the spermatic cord leading to constriction of the vascular supply and time-sensitive ischaemia and/or necrosis of testicular tissue.
Explain the aetiology/risk factors of testicular torsion.
Age under 25 years
Neonate
Bell clapper deformity
Trauma/exercise
Intermittent testicular pain
Undescended testicle
Cold weather
Summarise the epidemiology of testicular torsion.
In males <25 years of age, the annual incidence of torsion is 1 in 4000 in the US. Torsion can be seen at any age but it is not generally a disease affecting the elderly.
Recognise the presenting symptoms of testicular torsion. Recognise the signs of testicular torsion on physical examination.
Testicular pain
Intermittent or acute on-and-off pain
No pain relief upon elevation of scrotum
Scrotal swelling or oedema
Scrotal erythema
Reactive hydrocele
High-riding testicle
Horizontal lie
Nausea and vomiting
Abdominal pain
Identify appropriate investigations for testicular torsion and interpret the results.
Grey-scale ultrasound
Power Doppler ultrasound
Colour Doppler ultrasound
Generate a management plan for testicular torsion.
Manual de-torsion followed by surgical testicular exploration
Identify the possible complications of testicular torsion and its management.
Infarction of testicle/permanent testicular damage/loss of testicles
Infertility secondary to loss of testicle
Psychological implication of losing a testis
Cosmetic deformity
Recurrent torsion
Impaired pubertal development (significant or bilateral testicular loss)
Summarise the prognosis for patients with testicular torsion.
The adage ‘time is testicle’ applies to patients with testicular torsion because the longer it takes for diagnosis and definitive repair, the greater the likelihood that the patient will develop tissue necrosis, decreased tissue viability, decreased spermatogenesis, and possible infertility.
