Testicular Torsion Passmed

Question 1

What is testicular torsion and its common age group?

Answer 1

Testicular torsion involves the twist of the spermatic cord, leading to testicular ischaemia and necrosis. It is most common in males aged between 10 and 30 years, with a peak incidence from 13 to 15 years.

Question 2

Describe the typical features of testicular torsion.

Answer 2

Features include severe and sudden onset pain, pain referred to the lower abdomen, nausea and vomiting, swollen and tender upward retracted testis, reddened skin, loss of cremasteric reflex, and Prehn’s sign (elevation of the testis does not ease the pain).

Question 3

What is the management approach for testicular torsion?

Answer 3

Management of testicular torsion involves urgent surgical exploration. If torsion is confirmed, both testes should be fixed to prevent recurrence, as the condition is often bilateral.

Question 4

A male attends the emergency department with acute onset swollen and painful left testicle. On examination, there is an absent cremasteric reflex.

Which of the following features would best support the most likely diagnosis?

Perianal bruising
Retracted testicle
The pain was of gradual onset
Aged 32
Temperature of 37.9°C

Answer 4

Retracted testicle

In acute testicular pain, a unilateral swollen and retracted testicle, with loss of the cremasteric reflex, is characteristic of testicular torsion

Sudden onset testicular pain and swelling is most likely to be caused by testicular torsion. The absent cremasteric reflex further suggest that torsion is the most likely diagnosis. Other causes of testicular pain and swelling, such as epididymitis and epididymo-orchitis present with slower onset pain and swelling.

Perianal bruising is not seen in testicular torsion. This would be a sign of perianal haematoma.

Testicular torsion tends to present with sudden onset rather than gradual onset pain.

Testicular torsion is normally very painful. However, a pain score below 8/10 would not necessarily rule out torsion either.

A temperature would be more suggestive of an infective process such as epididymo-orchitis.

Testicular torsion typically occurs in adolescents. A 32-year-old male may develop this condition but other causes of testicular swelling should also be considered.