Testicular Torsion Flashcards
Define testicular torsion
When the spermatic cord and its content twists within the tunica vaginalis compromising the blood supply to the testicle.
It is a surgical emergency and can lead to infarction within hours.
Can happen at any age but peak is in neonates and 12-25yo
Pathophysiology
Occurs when a mobile testis rotates on the spermatic cord.
This leads to reduced arterial blood flow, impaired venous return, venous congestion, oedema and infarction if not corrected.
Who is more prone to testicular torsion
Males with a horisontal lie of their testes
This is called bell-clapper deformity.
There is a lack of normal attachment to the tunica vaginalis making it more mobile and increasing the likelihood of torsion.
Explain neonatal testicular torsion
The attachment between the scrotum and tunica vaginalis is not fully formed.
This means that the entire testis and tunica vaginalis can be tort.
This shoudl always be thoroughly examined at their first check.
This type is extra-vaginal torsion
Risk factors
Age 12-25
Previous testicular torsion
FH
Undescended testes
Clinical features
Sudden onset severe unilateral testicular pain
Often N+V secondary to pain
There might be referred abdo pain as well
Examination findings
High position of the testis compared to contralateral side
Horisontal lie
It can be swollen and very tender
Cremasteric reflex is absent
-ve Prehn’s sign
Dx
Epididymo-orchitis
Trauma
Incarcerated inguinal hernia
Testicular cancer
Renal colic
Hydrocoele
Idiopathic scrotal oedema
Torsion of the hydatid of Morgagni
Explain Torsion of the Hydatid of Morgagni
The hydatid of Morgagni is a remnant of the Mullerian duct and is a common testicular appendage. This structure can also become torted, presenting with similar sudden onset pain.
Torsion of these structures is more common in a younger age group than testicular torsion, and the scrotum is usually less erythematous with a normal lie of the testis.
The ‘blue dot’ sign may be present in the upper half of the hemiscrotum, which is the visible infarcted hydatid.
Ix
Clinical diagnosis
Any suspected case should be taken straight to theatre for scrotal exploration
Doppler USS or urine dipstick might be done first but shouldn’t be
Management
Surgical emergency with 4-6h window from onset of symptoms.
Urgent surgical exploration with strong analgesia and anti-emetics pre-op.
Surgical management
Torsion is confirmed intra-operatively
Cord and testis should be untwisted and both testicles fixed to the scrotum.
This is called bilateral orchidopexy and is done to prevent any further torsion episodes.
If the testis is not viable anymore, orchidectomy should be done, a prosthesis might be inserted if requested.
Complications
Testicular infarction
Atrophy
Chronic pain
Atrophy of contralateral testicle
