Urology: Testicular Torsion Flashcards
Outline the pathophysiology of testicular torsion
Twisting of spermatic cord structures and subsequent loss of the blood supply to the ipsilateral testicle = surgical emergency
Rate of testicular viability decreases significantly after 6 hours from onset of symptoms
Twisting of the testicle causes venous occlusion and engorgement as well as arterial ischemia and infarction of the testicle
Bell-clapper deformity (commonly adolescents) = attachment of tunica vaginalis to the testicle is inappropriately high, spermatic cord can rotate within it = intravaginal torsion
Extravaginal torsion (commonly neonates) = tunica vaginalis is not yet secured to the gubernaculum and, therefore, the spermatic cord, as well as the tunica vaginalis, undergo torsion as a unit
Outline the aetiology of testicular torsion
Bell-clapper deformity
Abnormal mesentery between testis
Neonatal rotation prior to the development of testicular fixation via the tunica vaginalis
What are the signs and symptoms of testicular torsion?
Sudden onset (may be related to trauma) of severe unilateral scrotal pain
Followed by inguinal and/or scrotal swelling
Nausea
Vomiting
Absence of cremasteric reflex
Abnormal testicular direction
Painful urination
Scrotal erythema
How should testicular torsion be investigated?
Surgical exploration
Scrotal exam = diff due to pain and scrotal oedema
TWIST scoring = testis swelling (2 points), hard testis (2), absent cremasteric reflex (1), nausea/vomiting (1), high-riding testis (1)
Urinalysis = exclude UTI
Outline the management of testicular torsion
If Hx/exam strongly suggest testicular torsion, pt should go directly to surgery
Orchiopexy = testis is anchored to the scrotal wall
Orchietomy = if the testis is necrotic
What are the possible complications of testicular torsion?
Infarction of testicle
Loss of testicle
Infection
Infertility secondary to loss of testicle
Cosmetic deformity
