Testicular torsion Flashcards
Define testicular torsion
Twisting/torsion of the spermatic cord results in venous outflow obstruction from the testicle, progressing to arterial occlusion & testicular infarction if not corrected
SURGICAL EMERGENCY
Aetiology of testicular torsion
2 types
INTRAVAGINAL (most common)
Spermatic cord twists within the tunica vaginalis
EXTRAVAGINAL (usually in neonates)
Entire testis & 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 for testicular torsion
2
Imperfectly descended testes
High investment of the tunica vaginalis
Epidemiology of testicular torsion
Most common cause of acute scrotal pain in 10-18 yr olds
Presenting symptoms of testicular torsion
3
Sudden onset severe hemiscrotal pain
Abdominal pain
N&V
Signs of testicular torsion on physical examination
5
Swollen, erythematous scrotum on affected side
Swollen testicle will lie slightly higher than unaffected one
Testicle might lie horizontal
Thickened cord
Testicular appendix
may be a visible necrotic lesion on transillumination
Differentials of testicular torsion-like presentation
2
Epididymo-orchitis
Incarcerated inguinal hernia
Investigations for testicular torsion
3
Do NOT delay surgery
Doppler/duplex imagine of testes
Arterial inflow
REDUCED in testicular torsion
INCREASED in epididymo-orchitis
Management of testicular torsion
3
Exploration of scrotum within 6 hrs of onset of symptoms
After testicle is twisted back into place, bilateral orchidopexy is performed
If testicle is necrotic, orchidectomy may be performed
Complications of testicular torsion
4
Testicular infarction
Testicular atrophy
Infection
Impaired fertility (due to production of anti-sperm antibodies)
Prognosis of testicular torsion
2
From onset of torsion, testicle may only survive 4-6hrs
With prompt surgical intervention most testicles salvaged
