Testicular Torsion Flashcards
What is testicular torsion?
A urological emergency caused by twisting of the spermatic cord & it’s contents, compromising the blood supply & eventually resulting in time-sensitive testicular ischaemia / necrosis.
When is it’s peak incidence?
In neonates & young males (12-25 yo)
What is the pathophysiology?
Mobile testis rotates on spermatic cord causing:
- Reduced arterial blood flow
- Impaired venous return & venous congestion w/ oedema
== In this anatomical variant –
What are the risk factors?
- Age (Neonate or 12-25 yo)
- Prev. torsion
- Family Hx
- Undescended testes
- Bell clapper deformity
- Horizontal lie to testes
How does bellclapper deformity increase likelihood of testicular torsion?
Testis lacks normal attachment to tunica vaginalis, therefore is more mobile, increasing the likelihood of twisting.
What are the features of testicular torsion?
- Sudden onset of severe unilateral testicular pain
- Pain can refer to abdomen
- Associated with nausea and vomiting
What signs are seen on examination of a patient with testicular torsion?
- Appearance of testis:
- High position compared to contralateral side w/ horizontal lie
- Swollen & tender
- Absent Cremasteric reflex
- Negative Prehn’s Sign
- Pain will continue despite elevation of testicle
What are you differential diagnoses?
- Epididymo-Orchitis
- Trauma
- Incarcerated inguinal hernia
- Testicular cancer
- Renal colic
- Hydrocele
- Idiopathic scrotal oedema
- Torsion of the hydatid of Morgagni
What is the significance of testicular torsion as a surgical emergency?
There’s a window of 4-6 hours from the onset of symptoms to salvage the testis before significant ischaemic damage occurs.
How is testicular torsion investigated?
- Urgent surgical exploration
- FOR ANY SUSPECTED CASE
- To assess the testes and the spermatic cord for evidence of torsion.
-
Doppler USS
* To investigate compromised blood flow -
Urine dip
* To assess for potential infection
What pre-operative care is required prior to urgent surgical exploration?
- Suitable strong analgesia
* Morphine sulfate -
Anti-emetics
* Ondansetron
3. NBM w/ maintenance fluids
How do you manage confirmed testicular torsion?
- Bilateral reduction & orchidoplexy
- Cord and testis untwisted (Reduction)
- Both testicles fixed to the scrotum, to prevent further torsion episodes (Orchidoplexy)
-
Orchidectomy w/ orchidoplexy of contra-lateral testes
* With non-viable testes
+/- Prosthesis
- Can be inserted at time of surgery or at a later date, at the patient request.
- For purely cosmetic purposes.
What complications can arise with delayed surgical exploration of testicular torsion?
Testicular infarction
- Chances increase exponentially w/ time since onset of pain
What complication can arise despite surgical management?
Testicular atrophy
What should patients be consented for prior to surgery?
- Chronic pain
- Palpable suture
- Risk to future fertility
- Theoretical risk of future torsion
What are the clinical differences in epididymo-orchitis?
- Inital presentation of EO
- Pain onset is more gradual
- Can be associated with LUTS or pyrexia
- +ve Prehn’s Test in EO
- Normal Cremasteric reflex in EO
