Testicular Torsion

Question 1

What is Testicular Torsion?

Answer 1

• spermatic cord and its contents twists within the tunica vaginalis, compromising the blood supply to the testicle

Question 2

Which cells are most susceptible to ischaemiea?

Answer 2

• Germ cells

Question 3

Which age group is commonly affected in TT?

Answer 3

• 12-18

Question 4

What are the two types of TT?

Answer 4

• Intravaginal torsion (bell-clapper deformity)
  
  • lack of normal fixation of the posterior lateral aspect of the testes to the tunica vaginalis
  • testis being free to swing and rotate within the tunica vaginalis of the scrotum
• Extravaginal torsion (neonatal testicular torsion)
  
  • occurs in utero or around the time of birth before the testis is fixed in the scrotum by the gubernaculum.

Question 5

What are the RF for TT?

Answer 5

• Age (most common 12-25yrs)
• Previous testicular torsion*
• Family history of testicular torsion
• Undescended testes

Question 6

What will be the typical hx of TT?

Answer 6

• sudden onset, severe pain in one testis
• lower abdominal pain
• comes during physical activity
• brief episodes of similar pain

*pain eases as necrosis sets in

Question 7

What will you find on examination of TT?

Answer 7

• reddening of the scrotal skin
• swollen, tender testis retracted upwards
• negative Prehn’s sign
• testes on both sides are characteristically in the ‘bell-clapper position’
• absence of the cremasteric reflex

Question 8

What are the differential diagnosis for TT?

Answer 8

• Torsion of Hydatid of Morgagni (testicular appendage)
• Epididymo-Orchitis
• Hydrocoele
• Incarcerated hernia
• testicular tumour
• Mumps

Question 9

What Ix would you order for TT?

Answer 9

• Clinicl diagnosis
• Take straight for surgical exploration

For completion

• DUSS: + whirlpool sign
• Urine dipstick

Question 10

How would you Mx TT?

Answer 10

Pre-operative

• strong analgesia
• anti-emetics
• nil by mouth
• maintenance fluids

Surgery

• surgical exploration (4-6 hrs window)
• bilateral orchidopexy - testicles fixed to scrotum, prevent future TT
• orchidectomy - if testis non viable

Question 11

What are the cx of TT?

Answer 11

• Testicular infarction
• Testicular atrophy

Question 12

What are the cx of scrotal exploration?

Answer 12

• chronic pain
• palpable suture
• risk to future fertility
• future torsion despite fixation.