Testicular Torsion

Question 1

Presentation of testicular torsion

Answer 1

• Typically in teenage boys, but can occur at any age
• Acute/sudden onset of unilateral testicular pain
• Often triggered by activity (i.e. playing sports)
• “6 hour window” after onset before damage from ischaemia is irreversible
• Major complication is subfertility/infertility

Question 2

Examination in testicular torsion

Answer 2

• Acutely tender testicle
• Firm testicle
• Absent cremasteric reflex
• Abnormal lie
  
  • Horizontal lie
  • Rotated so that epididymis is not in normal posterior position
  • Elevated (retracted) testicle

Question 3

Bell-clapper deformity

Answer 3

• Normally the testicle is fixed posteriorly to the tunica vaginalis
• Bell-clapper deformity is where this fixation is absent
• Allows testicle to rotate within tunica
• As it rotates it twists the vessels and cuts of its blood supply

Question 4

Management of testicular torsion

Answer 4

• Urgent urology assessment
• Immediate surgical scrotal exploration
  
  • Untwist the testicle
  • Both testicles are fixed in correct position to prevent further episodes (orchiplexy)
  • Possible orchiectomy if delayed surgery/necrotic testicle present