Testicular Torsion

Overview

• Testicular torsion involves the twisting of the spermatic cord and rotation of the testicle.
• It is a urological emergency which, if untreated, can lead to ischemia, necrosis, and potentially infertility.
• Urgent action is crucial to prevent the death of the testicle.
• Most common in teenage boys but can occur at any age.
• History of intermittent testicular torsion may be present in some patients.

Presentation

• Triggered by activities such as playing sports.
• Rapid onset of unilateral testicular pain.
• Associated symptoms: abdominal pain and vomiting.
• Sometimes only abdominal pain is present, necessitating testicular examination.

Examination Findings

• Firm, swollen, and elevated/retracted testicle.
• Absence of cremasteric reflex.
• Abnormal testicular lie: horizontal position, rotation, and displaced epididymis.
• Immediate senior urology opinion required if torsion is suspected.

Bell Clapper Deformity

• A potential cause of testicular torsion.
• Normal fixation between testicle and Tunica vaginalis is absent.
• Testicle hangs horizontally and can rotate, twisting spermatic cord and blood vessels.

Management

• Treat as a urological emergency.
• Delay in treatment reduces chances of testicle preservation.

Steps in Management

1. Make patient nil by mouth for surgery preparation.
2. Provide analgesia as required.
3. Get urgent senior urology assessment.
4. Perform surgical exploration of the scrotum.
5. Surgical interventions:
   • Orcheopexy: Corrects and fixes the position of the testicles.
   • Orchidectomy: Removal of the testicle if necrosis is present or there’s a delay in surgery.

Diagnosis

• Scrotal ultrasound can confirm torsion but should not delay surgery.
• "Whirlpool sign" on ultrasound suggests twisted spermatic cord.

Additional Resources

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