Testicular torsion

Question 1

What is the definition of testicular torsion?

Answer 1

Twisting of the spermatic cord

Question 2

Why is testicular torsion an emergency?

Answer 2

Can lead to ischaemia of the testicle

Question 3

What are the risk factors for testicular torsion?

Answer 3

Being young: most common 11-30
Having a history of torsion
Maybe having an STD

Question 4

What are the differentials for testicular torsion?

Answer 4

Epididymitis
Orchitis 
Epididymo-orchitis 
Tumour of testis 
Scrotal oedema 
Traumatic rupture

Question 5

What are the signs of testicular torsion?

Answer 5

Unilateral inflammation of testicle
Severe pain
Nausea
Vomiting

Question 6

What is the criteria used to score the severity of the torsion?

Answer 6

TWIST 
Testis swelling - 2
Hard testis - 2
Absent cremaster reflex - 1
Nausea/vomiting - 1
High testis - 1
Higher score -> higher risk of TT

Question 7

What is important to ask in the history?

Answer 7

Has there been similar symptoms that resolved before?
Is the patient sexually active?
Description of pain

Question 8

What are the investigations for testicular torsion?

Answer 8

USS doppler for confirmation

Question 9

What is the management for testicular torsion?

Answer 9

Analgesia
Antiemetic 
URGENT urology referral for exploration 
URGENT scrotal exploration and bilateral orchidopexy
Potential manual detorsion

Question 10

What is the prognosis for testicular torsion?

Answer 10

Testicular salvage rates are 90-100% if surgery performed within 6hrs of onset of pain
This decreases to 50% if symptoms are present for more than 12 hours