Testicular torsion

Question 1

Define testicular torsion

Answer 1

Want to make sure they don’t lost it
Anyone with testicular pain needs to be screened-
or with lumps

Cancer is painless, torsion isn’t

dont want a late diagnosis -more than 6h is v bad

can also have torsion appendix testis-cannot tell the difference except blue dot sign-remove appendix and feel better

Question 2

Aetiology and risk factors of testicular torsion

Answer 2

Rare beyond 35y
Underlying deformity-tend to have long tunica vaginalis, etc
so if affects one side is very likely to affect the other
can be caused by trauma, or canal wrapping around (clapper bell)

risk factors
younger men
Boys
PMH of torsion

Question 3

Epidiemology of testicular torsion

Answer 3

Rare -1in 4000

VERY VERY rare over 35

Question 4

Signs and Sx

Answer 4

Swollen, tender, 
high riding (affected might be higher)
intermittent very severe pain
No relief when lifting testicule
but no fever like epidimylytis

if goes on over 6h-probably loss of the testicule forever-but fertility not affected

need a good Hx

Question 5

Investigations of testicular torsion

Answer 5

Ultrasound can help diagnose to make sure before surgery

Exploration by surgery which is often followed by immediate relief

need to be diagnosed and relief within 6H to make sure no permanent damage and no orchiectomy

Question 6

Management of testicular torsion

Answer 6

A&E always-have 6h
Pain killers, antiemetics
immediate surgical exploration, then they relief the torsion and explore the 2nd testicule (Often same anatomical problems)

can potentially manual de-torsion

Question 7

Complications of testicular torsion

Answer 7

After 6h, death of the tissue in the testicule-infarct-orchectomy needed-

no infertility related to only having 1 testicule

can offer prothetic for looks

RECCURENT torsion is likely

Question 8

Prognosis of testicular torsion

Answer 8

Need to be as fast as possible in diagnosis and investigation and surgery. every min is crucial to save testicule

but if manage under 4h from start-good prognosis

the sutures can fail years later-so can happen again-