Testicular Torsion Emergency

Question 1

What are RFs of testicular torsion?

Answer 1

• undescended tesis

- Bell clapper deformity

Question 2

What is the presentation of testicular torsion?

Answer 2

• age 12-18
• acute onset
• severe intensity
• absent swelling

Question 3

What will you see on PE for testicular torsion?

Answer 3

• tender, firm testis
• high riding testis
• horizontal lie
• absent cremaster reflex***
• no pain relief w/ elevation
• thick/knotted sperm cord

Question 4

What dx tests can you use for testicular torsion?

Answer 4

Doppler U/S

Nuclear testicular scan

Question 5

What will you see on doppler U/S in testicular torsion vs epididymitis/orchitis?

Answer 5

TT: Minimal BF

Epididymitis: increased BF

Question 6

What will you see on the nuclear testicular scan in testicular torsion vs epididymitis/orchitis?

Answer 6

TT: Decreased radiotracer activity

Epididymitis: increased radiotracer activity

Question 7

What is a temporary fix for testicular torsion?

Answer 7

Manual detorsion: “open the book”

Question 8

If testis is viable, what surgical option is available?

Answer 8

Orchiopexy of both sides

Question 9

If testis is NOT viable, what surgical intervention is required?

Answer 9

Orchiectomy

Orchiopexy of contralateral testis

Question 10

What determines if the testis is viable?

Answer 10

If detorsion < 6 hrs = viable

If detorsion > 24 hrs = non-viable