Testicular torsion

Question 1

What is testicular torsion?

Answer 1

Testicular torsion occurs when the spermatic cord and its contents twists within the tunica vaginalis, compromising the blood supply to the testicle.

Question 2

What are risk factors for testicular torsion?

Answer 2

• Age 12-25
• Previous torsion
• Family history
Undescended testes

Question 3

What are Sx of testicular torsion?

Answer 3

• Sudden onset severe unilateral testicular pain
• Nausea and vomiting
• Referred abdominal pain
• Testis in high position compared to other side with a horizontal lie
• Swollen and tender testis, with erythema
• Cremasteric reflex is absent
Negative Prehn’s test

Question 4

What are DDx for testicular torsion?

Answer 4

• Epididymo-orhocitis: this is normally associated with a more gradual onset of pain and can be associated with LUTS and / or pyrexia.
	• Inguinal hernia
	• Testicular cancer
	• Renal colic
Hydrocoele

Question 5

What are Ix in testicular torsion?

Answer 5

Clinical diagnosis.

US Doppler to show reduced blood flow

Routine bloods> WBC and CRP would suggest epididymo-orchitis

Question 6

What is Rx of testicular torsion?

Answer 6

Urgent surgical exploration to asses testes and spermatic cord for evidence of torsion.

Bilateral orchidoplexy: both testicles fixed to scrotum to prevent recurrence

* Analgesia (morphine)
* Anti-emetic (ondansetron)

Can try manual if surgical is not available

Question 7

What are complications of testicular torsion?

Answer 7

• Loss of testis
  
  • Infertility secondary to loss of testicle
  • Chronic pain
  • Psychological impact
  • Recurrent torsion
  • Impaired pubertal development if neonatal