Testicular Torsion

Question 1

What is testicular torsion?

Answer 1

SURGICAL EMERGENCY.
Twisting of spermatic cord results initially in venous outflow obstruction from the testicle, progressing to arterial occlusion + testicular infarction if not corrected.

Question 2

What are the 2 types of testicular torsion? Which is most common?

Answer 2

Intravaginal (MOST COMMON)

Extravaginal (neonates)

Question 3

What is intravaginal testicular torsion?

Answer 3

Spermatic cord twists within the tunica vaginalis

Question 4

What is extravaginal testicular torsion? In which demographic is this usually seen?

Answer 4

Neonates
Entire testis + tunica vaginalis twist in a vertical axis on the spermatic cord
Due to incomplete fixation of the gubernaculum to the scrotal wall allowing free rotation

Question 5

Give 2 risk factors of testicular torsion

Answer 5

Imperfectly descended testes

High investment of the tunica vaginalis

Question 6

Describe the epidemiology of testicular torsion

Answer 6

Most common cause of acute scrotal pain in 10-18 yr olds

Question 7

List 3 symptoms of testicular torsion?

Answer 7

Sudden-onset severe hemiscrotal pain
Abdominal pain
N+V

Question 8

List 5 signs of testicular torsion

Answer 8

Swollen, erythematous scrotum on affected side
Swollen testicle will lie slightly higher than unaffected
Testicle might lie horizontal
Thickened cord
Testicular Appendix: a visible necrotic lesion on transillumination

Question 9

Give 2 other differentials that may be considered on suspicion of testicular torsion?

Answer 9

Epididymo-orchitis

Incarcerated inguinal hernia

Question 10

What investigations should be performed in testicular torsion?

Answer 10

Doppler/ Duplex Imaging of the Testes
Arterial inflow
REDUCED in testicular torsion
INCREASED in epididymo-orchitis

Question 11

What must you not do in testicular torsion?

Answer 11

Do NOT delay surgery

Question 12

Describe the management of testicular torsion

Answer 12

Exploration of scrotum within 6 hrs of onset of sx
After testicle is twisted back into place, a bilateral orchidopexy is performed; suturing the testicle to the scrotal tissue to prevent recurrence

Question 13

When is an orchidectomy performed?

Answer 13

If testicle is necrotic

Question 14

List 4 complications of testicular torsion

Answer 14

Testicular infarction
Testicular atrophy
Infection
Impaired fertility (due to production of anti-sperm antibodies)

Question 15

Describe the prognosis of testicular torsion

Answer 15

From onset of torsion, a testicle may only survive 4-6 hrs

With prompt surgical intervention, most testicles are salvaged