Testicular Torsion Flashcards
Define Testicular Torsion?
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
What are the two types of the aetiology of Testicular Torsion?
Intravaginal (MOST COMMON)
Extravaginal (usually in neonates)
What is the Intravaginal aetiology of Testicular Torsion?
The spermatic cord twists within the tunica vaginalis
What is the extravaginal aetiology of Testicular Torsion?
The entire testis and tunica vaginalis twists in a vertical axis on the spermatic cord
Due to incomplete fixation of the gubernaculum to the scrotal wall allowing free rotation
What are the risk factors for Testicular Torsion?
Imperfectly descended testes
High investment of the tunica vaginalis
What is the epidemiology of Testicular Torsion?
Most common cause of acute scrotal pain in 10-18 yr olds
What are the presenting symptoms of Testicular Torsion?
Sudden-onset severe hemiscrotal pain
Abdominal pain
Nausea and vomiting
What are the signs of Testicular Torsion on physical examination?
Swollen, erythematous scrotum on the affected side
Swollen testicle will lie slightly higher than the unaffected one
Testicle might lie horizontal
Thickened cord
What might you see on the Testicular Appendix for Testicular Torsion?
There may be a visible necrotic lesion on transillumination
What are the differential diagnoses of Testicular Torsion?
Epididymo-orchitis
Incarcerated inguinal hernia
What investigations do we do for Testicular Torsion?
Doppler/Duplex imaging of the testes
What do we see in Doppler/Duplex Imaging of the Testes in Testicular Torsion?
Arterial inflow:
- Reduced in Testicular Torsion
- Increased in epididymo-orchitis
DON’T DELAY SURGERY
What is the management plan for Testicular Torsion?
Exploration of the scrotum within 6 hrs of onset 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
What are the possible complications of Testicular Torsion?
Testicular Infarction
Testicular atrophy
Infection
Impaired fertility (due to production of anti-sperm antibodies)
What is the prognosis for patients with Testicular Torsion?
From the onset of torsion, a testicle may only survive 4-6 hrs
With prompt surgical intervention, most testicles are salvaged
