Testicular Torsion Flashcards
Define
a SURGICAL EMERGENCY. Twisting or torsion of the spermatic cord results, initially, in venous outflow obstruction from the testicle, progressing to arterial occlusion and testicular infarction if not corrected.
Causes
Intravaginal (MOST COMMON)
- The spermatic cord twists within the tunica vaginalis
Extravaginal (usually in neonates)
- The entire testis and tunica vaginalis twist in a vertical axis on the spermatic cord
- Due to incomplete fixation of the gubernaculum to the scrotal wall allowing free rotation
Risk Factors
- Imperfectly descended testes
- High investment of the tunica vaginalis
Epidemiology
Most common cause of acute scrotal pain in 10-18 yr olds
Symptoms
- Sudden onset pain in ONE testis Makes walking uncomfortable
- ±Abdominal pain
- ±N&V
- Quite often a history of pervious, brief episodes of similar pain (due to previous torsion that corrected itself)
Signs
- Swollen, erythematous scrotum on the affected side
- Swollen testicle will lie slightly higher than the unaffected one
- Testicle might lie horizontal
- Thickened cord
Testicular Appendix
- There may be a visible necrotic lesion on transillumination
Differential Diagnosis
- Epididymo-orchitis
- Incarcerated inguinal hernia
Investigations
Doppler/Duplex Imaging of the Testes
Do NOT delay surgery
Arterial inflow
- REDUCED in testicular torsion
- INCREASED in epididymo-orchitis
Management
- Exploration of the scrotum within 6 hrs of onset of symptoms
- After the testicle is twisted back into place, a bilateral orchidopexy is performed
- This involves suturing the testicle to the scrotal tissue to prevent recurrence
- If the testicle is necrotic, orchidectomy may be performed
Complications
Testicular infarction
Testicular atrophy
Infection
Impaired fertility (due to production of anti-sperm antibodies)
Prognosis
From the onset of torsion, a testicle may only survive 4-6 hrs
With prompt surgical intervention, most testicles are salvaged
