Condition- Testicular Torsion

Question 1

What is testicular torsion

Answer 1

Twisting of the spermatic cord leading to testicular ischaemia and necrosis

Question 2

Testicular torsion can be classified into intra-vaginal and extra-vaginal torsion- what is the difference between these two?

Answer 2

• INTRAVAGINAL: spermatic cord twists within tunica vaginalis (most common)
• EXTRAVAGINAL: The entire testis and tunica vaginalis twist in a vertical axis on the spermatic cord (in neonates)

Question 3

List some the symptoms of testiular torsion

Answer 3

• SUDDEN ONSET SEVERE HEMISCROTAL PAIN (one testis)
• uncomfortable walking
• abdo pain
• N+V

Question 4

Describe the appearnace of the testicles after torsion on physical examination

Answer 4

• Swollen, erythematous scrotum on affected side
• Affected side lies higher + more horizontal
• Upon transillumination may see necrotic lesion

Question 5

List two conditions which may be confused for testicular torsion

Answer 5

• Epididymo-orchitis- onset is more gradual
• Incarcerated Inguinal hernia

Question 6

Which investigation could you conduct to differentiate epididymo-orchitis from testicular torsion and what would be the result of this investigation?

Answer 6

Doppler/Duplex Imaging of the Testes

Looks at arterial inflow

• REDUCED in testicular torsion (because of obstruction)
• INCREASED in epididymo-orchitis (because of inflammatory response)

Question 7

How quickly must surgery be undertaken after the onset of torsion for the testicle to survive?

Answer 7

4-6hrs