Testicular torsion Flashcards
Define testicular torsion
The twisting of the spermatic cord in the tunica vaginalis resulting in the occlusion of blood vessels supplying the testes.
Is testicular torsion an emergency?
Yes it is an emergency.
At first the venous supply will be obstructed, followed by the arterial supply leading to testicular infarction.
What are the risk factors for testicular torsion?
- Under 25
- Neonates
- Bell clapper deformity
What is the Bell clapper deformity?
Allows testicles to rotate freely in the tunica vaginalis
What are the two types of testicular torsion?
- Intravaginal - spermatic cord twists in the tunica vaginalis
- Extravaginal - the entire testis and tunica vaginalis twist in a vertical axis on the spermatic cord
What is the epidemiology of testicular torsion?
- Extra-vaginal mostly affects neonates
- Intra-vaginal mostly affects adolescent boys
- Is not a disease of the elderly
What are the presenting symptoms of testicular torsion?
- Pain in one testicle of sudden onset
- Abdo pain
- Discomfort when walking
- Vomiting
What are the signs on physical examination of testicular torsion?
- swollen, erythematous scrotum on affected side
- Affected testicle may be lying slightly higher
- Affected testicle might be lying horizontally
- Thickened cord
What are the appropriate investigations for testicular torsion?
- Doppler USS of testes
What will the blood flow to the testes tell you about your differential diagnosis?
- REDUCED flow = testicular torsion
2. INCREASED flow = epididymo-orchitis
What is the management for testicular torsion?
Emergency surgery
- After testes is twisted back = orchidopexy performed
- If testes necrotic = orchidectomy
What are the possible complications of testicular torsion?
- Testicular infarction
- Infertility issues
- Testicular atrophy
What is the prognosis for testicular torsion?
From the onset of torsion, a testicle may only survive 4-6 hrs. With prompt surgical intervention, most testicles are salvaged
