Testicular torsion (Complete)

Question 1

What is testicular torsion?

Answer 1

Twisting of the spermatic cord resulting in ischaemia and necrosis

Question 2

What age does testicular torsion most commonly present?

Answer 2

Between 10-30 (peak incidence 13-15 years)

Question 3

What are the main features of testicular torsion?

Answer 3

Symptoms
Unilateral testicular pain: Severe, sudden-onset and can radiate to lower abdomen

Nausea and vomitting may present (due to pain)

Signs:

Swollen, tender testes retracted upwards

High-riding testes in scrotum

Unilateral loss of cremasteric reflex

Negative Prehn’s sign (Elevation does not ease pain)

Reactive hydrocele (in some cases)

Erythema (in some cases)

Question 4

What are the main characterisitcs of pain in testicular torsion?

Answer 4

Severe

Sudden-onset

May radiate to lower abdomen

Question 5

What is the cremasteric reflex?

Answer 5

Contraction of cremasteric muscle, causing testes to be pulled towards inguinal canal.

Triggered when stroking inner thigh of ipsilateral testicle

Question 6

What is the management for patients suspected of having testicular torsion?

Answer 6

Nil by mouth: Preperation for therapy

Analgesia

Urgent senior urology assesment

Surgery

Urgent surgical exploration with fixation of testes with orchidoplexy

Orchidectomy: If testes is unsalvageable (e.g. delay in surgery or necrosis)

Question 7

What deformity is a common cause of testicular torsion?

Answer 7

Bell clapper deformity

Question 8

What investigation can be considered in patients suspected of testicular torsion?

Answer 8

Scrotal ultrasound: Not reccomended if it delays surgery

Question 9

What findings on ultrasound are suggestive of testicular torsion?

Answer 9

Whirlpool sign