testicular torsion + epididymitis & orchitis Flashcards
define testicular torsion + presentation of it.
spermatic chord and contents twists within tunica vaginalis.
sudden onset severe unilateral testicular pain, associated with nausea and vomiting.
testes will be higher than normal, and also lie horizontal.
it will be swollen, tender.
no cremasteric reflex
pain continues despite elevation of testicle (-ve Phrens)
risk factors for Testicular torsion + differential diagnosis
Age (12-25)
previous testicular torsion
family history of testicular torsion
undescended testes.
bell-clapper deformity
going from hot to cold quickly (can shrink and catch them in a rotated pstn)
epididymo-orchitis (more gradual pain +/- LUTS +/- fever)
rule out hernias, cancer, hydrocele.
torsion of the hydatid or morgagni (mullerian duct remmnant - see photo you get small area of infarction)
testicular torsion investigation and management
clinical diagnosis - suspected cases should be taken to theatre immediately (within 6 hrs 90% salvage rate, more than 12 hrs- 50%)
untwist the testicle and fix with orchidopexy to the scrotum. if non viable testes- orchidectomy.
pt will need strong painkillers and anti-emetics
you can try untwist it yourself 90/ 180 degs (open book way) but not always effective
complications
if left untreated- arterial and venous blockage- inflammation and ischaemia. testicular infarction occurs.
surgically fixed tests may atrophy, be painful chronically, have fertility problems, may torsion again
what is the scoring system for testicular torsion
TWIST
Hard testis - 2
swelling -2
nausea/ vomiting - 1
absent cremasteric reflex- 1
high riding testes - 1
higher the score the higher the likelyhood, can use USS for low scores but high suspicion.
overview of epididymitis
as it says on the tin
infections here can spread to the testes- orchitis
important to rule out testicular torsion when this presents.
caused by bacterial infection - either due to retrograde flow of urine, or STI. (e.coli, chlamydia, gonorrhoea)
can be traumatic also.
RF: 20-39 (sexually active)
sex with full bladder
sports
viral infections (mumps)
S+S, Ix, Rx epididymitis
gradual scrotal pain and swelling
flank pain- to scrotum
LUTS
urethral discharge
Ix: history inc sexual, traumatic
physical exam- tender unilaterally
urinanalysis- blood is a good indicator + culture it
urethral swab
USS
Mx:
identify the organism and then treat (for STI- Ceftriaxone IM, doxy 10-14/7)
Ice
stop traumatic activities.
what is orchitis
inflammation of the testicle
isolated orchitis is very rare
usually occurs as a spread from epididymitis
complications- atrophy, impaired fertility, reactive hydrocele.
can also be caused by viruses, such as mumps
cremasteric reflex is normal
