Testicular Torsion Flashcards
Define testicular torsion
Urological emergency caused by twisting of the testicle on the spermatic cord -> restricted
blood supply -> ischaemia -> necrosis
What are the causes/risk factors of testicular torsion?
• Bell-clapper deformity • History of intermittent testicular pain (torsion and de-torsion) • Cryptorchidism • Trauma
What are the symptoms of testicular torsion?
- Sudden onset testicular pain
* Nausea & vomiting
What are the signs of testicular torsion?
- Scrotal swelling/oedema
- Scrotal erythema
- High-riding testicle
- Horizontal lie
- Absent cremasteric reflex
What investigations are carried out for testicular torsion?
- USS - presence of fluid and the whirlpool sign (the swirling appearance of the spermatic cord from torsion as the ultrasound probe scans downwards perpendicular to the spermatic cord)
- Doppler USS - arterial inflow may be increased in cases of torsion and decreased in epididymo-orchitis
What is the management for testicular torsion?
Surgical:
• Exploration of the scrotum should be performed ideally within 6 hours of symptoms:
- A horizontal or midline raphe incision is made through the skin and dartos muscle.
- The tunica vaginalis is opened and the testis is delivered and inspected.
- Untwisting is usually carried out by rotating laterally.
- The testis is allowed to re-perfuse, and is covered with a warm saline-soaked swab for a few minutes.
- This is followed by bilateral orchidopexy (fixation of testis by suturing the testes with nonabsorbable sutures to the scrotal tissues at three points of a triangle to prevent recurrence).
- If the testis is found to be necrotic, an orchidectomy is performed.
What are the complications of testicular torsion?
- Testicular infarction and atrophy if not treated promptly.
- If left, the testes may become infected or impair fertility by promoting formation of anti-sperm antibodies.
