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B - Paediatrics MANAGEMENT > Testicular Torsion > Flashcards

Testicular Torsion Flashcards

1
Q

What is testicular torsion?

A

When a testicle rotates, twisting the spermatic cord that brings blood to the scortum

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2
Q

What occurs as a result of twisting of the spermatic cord?

A

Reduced blood flow causing sudden and often severe pain and swelling

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3
Q

In what age group is testicular torsion most common?

A

Post-pubertal boys

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4
Q

Is testicular torsion limited to post pubertal boys?

A

No, it can occur at any age including newborns

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5
Q

What are the two types of testicular torsion?

A
  • Intravaginal

- Extravaginal

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6
Q

What is intravaginal testicular torsion?

A

When the torsion occurs within the tunica vaginalis

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7
Q

What is extravaginal testicular torsion?

A

When the torsion occurs outside the tunica vaginalis

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8
Q

Almost all torsion events in older boys are of which type?

A

Intravaginal

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9
Q

In which age group are extravaginal torsions commonly seen?

A

Perinatal cases

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10
Q

What forms the basis of all torsion events?

A

Twisting of the spermatic cord

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11
Q

When does ischaemia occur in testicular torsion?

A

When the twist is sufficient to obstruct arterial inflow

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12
Q

What can testicular ischaemia result in?

A

Infarction

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13
Q

What do lesser degrees of torsion often result in?

A

Obstruction of venous outflow?

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14
Q

What can venous outflow obstruction lead to?

A

Congestion and swelling of the testis

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15
Q

What is the main risk factor of intravaginal torsion?

A

Bell clapper deformity

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16
Q

What is a bell clapper deformity?

A

Where the testis lie horizontally within the tunica vaginalis and lack posterior anchoring

17
Q

What are the risk factors for extravaginal torsion?

A
  • Large birth weight
  • Difficult labour
  • Breech presentation
  • Overreactive cremasteric reflex
18
Q

How may testicular torsion present?

A
  • Acute onset pain
  • Redness and oedema of scrotal skin
  • N & V
  • Abnormal teste position
  • Absent cremasteric reflex
19
Q

Where may the pain localise in testicular torsion?

A

Groin or lower abdomen

20
Q

How may the testes be abnormally positioned in testicular torsion?

A

May be high riding and/or transversely oriented

21
Q

What test is diagnostic of testicular torsion?

A

Doppler ultrasound

22
Q

What result is seen on doppler ultrasound in torsion?

A

Absent Doppler signal in testicular parenchyma

23
Q

What is absent Doppler signal indicative of?

A

Lack of blood supply

24
Q

What test may be useful to rule out infective causes of testicular pain?

A

Urinalysis

25
Q

If acute torsion is suspected what should not be delayed?

A

Treatment

26
Q

What are some differentials for torsion?

A
  • Incarcerated hernia
  • Epididymitis
  • Henoch-Schonlein Purpura
  • Orchitis
  • Hydrocoele
27
Q

What conservative management technique is used in some cases?

A

Manual detorsion

28
Q

What does manual detorsion involve?

A

Untwisting the spermatic cord by manipulating the testis so the anterior surface rotates from medial to lateral

29
Q

What is manual detorsion mostly used for?

A

Buying time before surgical intervention

30
Q

Why is manual detorsion rarely used?

A

It is difficult

31
Q

What are the goals of surgery?

A
  • Confirmation of diagnosis
  • Assessment
  • Detorsion
  • (Removal of involved testis if necessary)
  • (Fixation of involved testis to prevent recurrence if appropriate)
32
Q

If torsion occurs in one of the testis what may be appropriate in terms of the other?

A

Fixation to prevent torsion in the future

33
Q

What is the main complication of testicular torsion?

A

Necrosis and loss of testicle

34
Q

What may occur as a result of removal of testicle(s)

A

Reduced fertility

B - Paediatrics MANAGEMENT (106 decks)

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