Testicular Torsion Flashcards Preview

Y3M - Urology > Testicular Torsion > Flashcards

Flashcards in Testicular Torsion Deck (13)
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1

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

2

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.

3

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.

4

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

5

Risk factors

Age 12-25

Previous testicular torsion

FH

Undescended testes

6

Clinical features

Sudden onset severe unilateral testicular pain

Often N+V secondary to pain

There might be referred abdo pain as well

7

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

8

Dx

Epididymo-orchitis

Trauma

Incarcerated inguinal hernia

Testicular cancer

Renal colic

Hydrocoele

Idiopathic scrotal oedema

Torsion of the hydatid of Morgagni

9

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.

10

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

11

Management

Surgical emergency with 4-6h window from onset of symptoms.

Urgent surgical exploration with strong analgesia and anti-emetics pre-op.

 

12

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.

13

Complications

Testicular infarction

Atrophy

Chronic pain

Atrophy of contralateral testicle