Torsion of testicles

Question 1

What is testicular torsion?

Answer 1

Testicular torsion is when tissues around the testicle are not attached well.
=> this can cause the testes to twist around the spermatic chord.
=> testicular ischaemia

*surgical emergency.

Question 2

What age is testicular torsion most common in?

Answer 2

Between 10 - 30 years

Peak incidence 13 - 15 years

Question 3

What is the presentation of testicular torsion?

Answer 3

Clinical diagnosis based on:

1. Sudden onset, severe pain in 1 testicle
   => pain my be referred to lower abdomen
2. Nausea & vomiting may be present
3. Follows minor trauma
4. High riding scrotum
5. Unilateral loss of cremaster reflex
6. No relief in pain on elevation of testicle (-ve Prehn’s sign)
7. O/E: swollen, red, tender testis retracted upwards

Question 4

How is testicular torsion managed?

Answer 4

Treatment:

1. Urgent surgical exploration with fixation of testicles with orchidoplexy.

=> if a torted testis is identified then both testis should be fixed as the condition of bell clapper testis is often bilateral.

Question 5

What are the complications of testicular torsion?

Answer 5

If testicular torsion is not treated immediately it can lead to damage to or death of a testicle due ischaemia.

=> necrotic testicle must be surgically removed => can effect fertility.