Testicular torsion (Complete) Flashcards
What is testicular torsion?
Twisting of the spermatic cord resulting in ischaemia and necrosis
What age does testicular torsion most commonly present?
Between 10-30 (peak incidence 13-15 years)
What are the main features of testicular torsion?
Symptoms
Unilateral testicular pain: Severe, sudden-onset and can radiate to lower abdomen
Nausea and vomitting may present (due to pain)
Signs:
Swollen, tender testes retracted upwards
High-riding testes in scrotum
Unilateral loss of cremasteric reflex
Negative Prehn’s sign (Elevation does not ease pain)
Reactive hydrocele (in some cases)
Erythema (in some cases)
What are the main characterisitcs of pain in testicular torsion?
Severe
Sudden-onset
May radiate to lower abdomen
What is the cremasteric reflex?
Contraction of cremasteric muscle, causing testes to be pulled towards inguinal canal.
Triggered when stroking inner thigh of ipsilateral testicle
What is the management for patients suspected of having testicular torsion?
Nil by mouth: Preperation for therapy
Analgesia
Urgent senior urology assesment
Surgery
Urgent surgical exploration with bilateral fixation of testes with orchidoplexy
Orchidectomy: If testes is unsalvageable (e.g. delay in surgery or necrosis)
What deformity is a common cause of testicular torsion?
Bell clapper deformity
Why is bilateral fixation of testes with orchidoplexy done vs unilateral?
Mainly because bell clapper deformity is a common cause of testicular torsion and presents bilaterally.
Fixing both testes will prevent future occurance in the unaffected testes
What investigation can be considered in patients suspected of testicular torsion?
Scrotal ultrasound: Not reccomended if it delays surgery
What findings on ultrasound are suggestive of testicular torsion?
Whirlpool sign
