Urology: Testicular Torsion Flashcards
What is testicular torsion?
Twisting of the spermatic cord with rotation of the testicle.
It is a urological emergency.
What can a delay in treatment of testicular torsion result in?
Increases risk of ischaemia and necrosis of the testicle, leading to sub-fertility or infertility.
Typical patient with testicular torsion?
Teenage boy (but can occur at any age).
There may be a history of recurrent symptoms in patients where there is intermittent testicular torsion.
What age is peak incidence of testicular torsion?
13-15 y/o
What is testicular torsion often triggered by?
Testicular torsion is often triggered by activity, such as playing sports –> Ask what the patient was doing at the time when the pain started!
Presentation of testicular torsion?
1) Acute rapid onset of unilateral testicular pain
2) May be associated with abdo pain and/or N&V
N.B. Sometimes abdominal pain is the only symptom in boys, and testicular examination to exclude torsion is essential.
Examination findings in testicular torsion?
1) Firm swollen testicle
2) Elevated (retracted) testicle
3) Absent cremasteric reflex
4) Abnormal testicular lie (often horizontal)
5) Rotation, so that epididymis is not in normal posterior position
6) Prehn’s sign: elevation of the testis does not ease the pain
What is the cremasteric reflex?
A superficial reflex found in human males that is elicited when the inner part of the thigh is stroked.
Stroking of the skin causes the cremaster muscle to contract and pull up the ipsilateral testicle toward the inguinal canal.
What is the Bell-Clapper deformity?
One of the causes of testicular torsion.
Normally, the testicle is fixed posteriorly to the tunica vaginalis.
A bell-clapper deformity is where the fixation between the testicle and the tunica vaginalis is absent so the testicle hangs in a horizontal position (like a bell-clapper) instead of the typical more vertical position.
How can the bell-clapper deformity lead to testicular torsion?
The testicle is able to rotate within the tunica vaginalis, twisting at the spermatic cord. As it rotates, it twists the vessels and cuts off the blood supply.
Management of testicular torsion?
Urological emergency!
1) Nil by mouth in preparation for surgery
2) Analgesia as required
3) Urgent senior urology assessment
4) Surgical exploration of the scrotum
5) Orchiopexy (correcting the position of the testicles and fixing them in place)
6) Orchidectomy (removing the testicle) if the surgery is delayed or there is necrosis
What is orchiopexy?
correcting the position of the testicles and fixing them in place
What investigation can confirm the diagnosis of testicular torsion?
A scrotal ultrasound –> but not recommended as will delay the patient going to theatre
What will US show in testicular torsion?
US can show the whirlpool sign, a spiral appearance to the spermatic cord and blood vessels.
Why should both testis be fixed if a torted testes is found during surgical exploration?
as the condition of bell clapper testis is often bilateral.
