Testicular Torsion

Testicular torsion is a urological emergency

  • Typically in teenage boys, but can occur at any age
  • Acute/sudden onset of unilateral testicular pain
  • Often triggered by activity (e.g. playing sports)
  • “6 hour window” after onset before damage from ischaemia is irreversible
  • Major complication is subfertility / infertility

 

Examination

  • Acutely tender testicle (often difficult to examine due to extent of tenderness)
  • Firm testicle
  • Absent cremasteric reflex
  • Abnormal lie
    • Horizontal lie
    • Rotated so that epididymis is not in normal posterior position
    • Elevated (retracted) testicle

 

“Bell-clapper Deformity”

  • Normally the testicle is fixed posteriorly to the tunica vaginalis
  • Bell-clapper deformity is where this fixation is absent
  • Allows testicle to rotate within tunica
  • As it rotates it twists the vessels and cuts of its blood supply

 

Management

  • Urgent urology assessment
  • Immediate surgical scrotal exploration
    • Untwist the testicle
    • Both testicles are fixed in correct position to prevent further episodes (orchiplexy)
    • Possible orchiectomy if delayed surgery / necrotic testicle present
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