Testicular torsion

Question 1

What is testicular torsion

Answer 1

twisting of the spermatic cord causing testiscular ischaemia and necrosis

viable for 6 hours

Question 2

What is cryptochordism

Answer 2

Undescended testes, more common in preterm baby

risks : torsion, infertility, testicular cancer

Question 3

How to manage unilateral cryptorchidism

Answer 3

review at 6-8 weeks, then at 3-5 months. refer to surgery if unresolved by 6 months

orchidopexy

Question 4

How to manage bilateral testicular torsion

Answer 4

review by senior within 24 hours, may want to do genetic or endocrine testing

Question 5

What is torsion of appendix testes

aka torsion of hyatid of morgagni

Answer 5

torsion of mullerian remnant that causes acute scrotal pain in infants

pain evolves over multiple days

Still requires immediate exploratory surgery as cannot be distinguised from true torsion

If a ‘blue dot’ is seen over the superior pole of the testes, no surgery may be needed, only simple analgesia.

Question 6

What is a blue dot sign?

Answer 6

If a ‘blue dot’ is seen over the superior pole of the testes, no surgery may be needed, only simple analgesia.

seen in torsion of appendix testes

Question 7

How does testicular torsion present

Answer 7

Severe sudden pain

Nausea + vomiting

tender testis retracted upwards

loss of cremasteric reflex

negative prehns signt

Question 8

What is the prehns sign

Answer 8

elevation of testes alleviating pain

positive = epididymo-orchitis
negative = torsion

Question 9

How to manage testicular torsion

Answer 9

Immediate admission (IV fluids, NBM, antiemetics)

Immediate surgical exploration = bilateral orchidopexy