Torsione testicolare

Question 1

Epidemiologia

Answer 1

Peak incidence: neonatal period (first 30 days of life) and during puberty (invece l’epididimite tipicamente è dell’età della presente attività sessuale)

Question 2

Fisiopatologia

Answer 2

Testicular torsion involves a sudden twisting of the spermatic cord associated with a poorly secured testicle.
Torsion result in venous engorgement with consequent arterial compromise, tissue ischemia, and possible infarction. Irreversible damage occurs after approx. 4-6 ore

Question 3

Clinica

Answer 3

• Abrupt onset testicular pain and/or pain in the lower abdomen
• Typically swollen and tender testicle and/or lower abdominal tenderness
• Nausea and vomiting
• Abnormal position of testicle
• Abnormal transverse lie
• Scrotal elevation
• Possible undescended testes (predisposes to testicular torsion)
• Absent cremasteric reflex (positivo in epididimite)
• Prehn sign: negative (A positive Prehn sign is the relief of pain during elevation of the testes and suggests epididymitis rather than torsion)

Question 4

diagnosi

Answer 4

ECOgrafia testicolare : segno del doppio testicolo (infarcimento venoso)

• Twisting of spermatic cord (whirlpool sign)
• Reduced or absent blood flow to/from the affected testis
• Heterogeneous appearance of testicular parenchyma indicates testicular necrosis

Question 5

Trattamento

Answer 5

Surgical intervention is recommended for suspected testicular torsion, regardless of radiological findings.

Testicular torsion is a medical emergency and should ideally be treated within 6 hours of the onset of symptoms for the best chance of testicular salvage. Manual detorsion in the ER may be attempted prior to surgery for immediate pain relief, but should not delay transferring the patient to the OR.

Question 6

Exporation surgery

Answer 6

Indication: suspected testicular torsion
Timing: ideally, within 6 hours of symptom onset [1]

Procedure
-Immediate surgical exploration of the scrotum with reduction (untwisting) and orchidopexy (allungamento, infatti tra le cause troviamo il testicolo ad ascensore, alterazione del gubernaculum testis e la brevità del funicolo) of the affected testis

• Orchidopexy of the contralateral testis is recommended because the risk of testicular torsion on the contralateral side increases with previous or current testicular torsion. (stessa tecnica utilizzata in caso di criptorchidismo, che ricordiamo vede il testicolo per il 60 % dei casi fermo all’orofizio esterno del canale inguinale, 15 % in sede addominale e 25% nel canale inguinale)
• Orchiectomy if the testis is grossly necrotic or nonviable

Because of the risk of infertility, surgical exploration of the scrotum is recommended in any patient suspected of having testicular torsion, even if manual detorsion has been attempted.