Urology - testicular torsion

Question 1

Examination findings in testicular torsion

Answer 1

Firm swollen testicle
Elevated (retracted) testicle
Absent cremasteric reflex
Abnormal testicular lie (often horizontal)
Rotation, so that epididymis is not in normal posterior position

Question 2

What can trigger/cause testicular torsion?

Answer 2

Often triggered by activity e.g. playing sports

Bell-clapper deformity is one of the causes of testicular torsion:

• fixation between the testicle and the tunica vaginalis is absent
• Testicle hangs in a horizontal position instead of more vertical (as normal)
• Able to rotate within the tunica vaginalis

Question 3

Management of testicular torsion

Answer 3

Urgent urological/surgical review

NBM in preparation of urgent orchidopexy

Analgesia as needed

May need orchidectomy if the surgery is delayed or there is necrosis

Scrotal USS scan can confirm diagnosis, but should go straight to theatre if there is any suspicion and investigations shouldn’t delay theatre treatment