Testicular Torsion Case

Question 1

What should be included on the differential of male groin pain?

Answer 1

contusion/trauma
groin muscle strain
STI/UTI/other infection
Torsion
inguinal hernia
Hydrocele
Varicocele
Femoral Nerve Impingement
Malignancy
Lymphadenopathy/Lymphadenities
Referred pain from hip, pylonephritis, renal colic, regional ileitis, appendicitis
Atypical/Self-inflicted

Question 2

What is testicular torsion?

Answer 2

it occurs when the testicle rotates on the spermatic cord, which is what provides the blood flow to the testicle

this cuts off flow of blood and causes sudden, severe pain and swelling

Question 3

Testicular torsion can occur at any age, but is most common in what age group?

Answer 3

10-25

Question 4

What strucctural thing might predispose a man to testicular torsion?

Answer 4

inadequate connective tissue within the scrotum

Question 5

What are the symptoms of testicular torsion?

Answer 5

sudden onset severe pain in one testicle (with or without previous predisposing event)
scrotal swelling
nausea/vomiting
light-headedness

Question 6

What are the signs and findings of testicular torsion?

Answer 6

extremely tender and enlarged testicular region

testicle on affected side is higher

Question 7

Which side is torsion more likely to occur on?

Answer 7

the right

Question 8

How is diagnosis of torsion confirmed?

Answer 8

ultrasound with doppler - can show decreased or absent blood flow to the affected testicle

Question 9

What is the treatment for torsion?

Answer 9

surgery is usually required and should be performed as soon as possible

the surgeon will untwist the spermatic cord and then stitch one or usually both testicles to the inside of the scrotum to prevent rotation

Question 10

Within six hours, the testicle can be saved about ___ of the time. 12 hours? 24 hours?

Answer 10

6 hours: 90%
12 hours: 50%
24 hours: 10%

Question 11

What is the long term complication if the issue isn’t fixed soon enough?

Answer 11

if blood supply is cut off to the testicle for a prolonged period o time, it may atrophy and need to be surgically removed

this can occur days to months after the torsion has been corrected

severe infection is possible as well

Question 12

What are the infectious causes of male groin pain?

Answer 12

UTI, STI, Urethrtitis, Epididymitis, prostatitis, cellulitis orchitis, herpes

Question 13

What are the lab options for the diagnosis of ghonorrhea or chlamydia?

Answer 13

either do a urethral swab or a urine test (best if first pee of the morning)