Testicular Torsion

Question 1

Testicular Torsion Epidemiology

Answer 1

• Common
• Typically occurs in neonates or post-pubertal boys
• Left side more commonly affected than the right
• Bilateral is rare

Question 2

Testicular Torsion Intravaginal vs Extravaginal

Answer 2

Intravaginal

• Testis not connected to tunica vaginalis; bell clapper deformity
• Lies horizontally

Extravaginal
-Both spermatic cord and tunica vaginalis undergo torsion

Question 3

Testicular Torsion Presentation

Answer 3

• Sudden, severe pain in one testis
• N/V
• Lower abdo pain
• Pain eases as necrosis sets in
• Often comes on during sport/activity
• Lifting testis releases pain
• Absence of cremasteric reflex

Question 4

Testicular Torsion Differentials

Answer 4

• Torsion of appendage (usually occurs 7-12 years, localised tenderness, blue dot sign)
• Epididymitis/Orchitis (epididymis tender as oppose to testis, usually result of STI)
• Hydrocele (painless, transillumination)
• Hernia
• Tumour
• Mumps (swelling of parotid glands)

Question 5

Testicular Torsion Ix

Answer 5

• USS with doppler (to see arterial flow)

- Urinalysis

Question 6

Testicular Torsion Management

Answer 6

• All cases of acute testicular pain are torsion until proven otherwise
• Refer to urology/surgery, withhold food
• Torsion can be relieved manually, causes immediate relief
• Orchiopexy still required after detorsion
• Contralateral testis should undergo orchidopexy as recurrence rate high

Question 7

Testicular Torsion Complications

Answer 7

-Necrosis, infertility, cosmetic deformity

Question 8

Testicular Torsion Prognosis

Answer 8

• Testicular salvage most likely if duration less than 6 hours
• If duration longer than 24 hours; testicular necrosis is usual

Question 9

Testicular Torsion Prevention

Answer 9

-Recurrent, intermittent pain with bell-clapper testis requires orchidopexy to prevent ischaemia of testis