foreign [Applause] [Music] ers.com in this video I'm going to be going through testicular torsion and you can find written notes on this topic at xerifinals.com testicular torsion or in the Urology section of the zero to finals surgery book so let's jump straight in testicular torsion refers to twisting of the spermatic cord with rotation of the testicle it's a Urological emergency and a delay in treatment increases the risk of ischemia and necrosis of the testicle which can lead to sub-fertility or infertility there's an urgent need to take action otherwise it could lead to death of the testicle and infertility the typical patient is a teenage boy but testicular torsion can occur at any age there may be a history of recurrent symptoms in patients where there is intermittent testicular torsion where the testicle twists and untwists intermittently let's talk about the presentation testicular torsion is often triggered by some sort of activity such as playing sports ask what the patient was doing at the time when the pain started as you may be able to identify a trigger it presents with an acute rapid onset of unilateral testicular pain pain in one testicle and there may be Associated abdominal pain and vomiting sometimes abdominal pain is the only symptom in boys and testicular examination to exclude torsion is essential the examination findings with a testicular torsion are a firm swollen testicle and elevated or retracted testicle absence of The cremasteric Reflex abnormal testicular lie often with a horizontal testicle and rotation so that the epididymis is not in the normal posterior position if there's any doubt about whether a patient might have testicular torsion always get an immediate senior Urology opinion let's talk about something called a bell Clapper deformity a bell Clapper deformity is one of the causes of testicular torsion normally the testicle is fixed posteriorly to the Tunica vaginalis so the Tunica vaginalis sits in front of the testicle attached a bell Clapper deformity is where the fixation between the testicle and the Tunica vaginalis is absent the testicle hangs in a horizontal position like a bell Clapper instead of the typical more vertical position the testicle is also able to rotate within the tunic of vaginalis twisting at the spermatic chord as it rotates it twists the vessels and cuts off the blood supply finally Let's Talk About Management testicular torsion is a Urological emergency and there's an urgent requirement for treatment any delay in treatment will prolong the ischemia to the testicle and reduce the chances of saving the testicle the management of testicular torsion involves making the patient nil by mouth in preparation for surgery analgesia as required urgent senior Urology assessment surgical exploration of the scrotum and if testicular torsion is found during surgical exploration there's two ways to manage it surgically either the patient will have an orcheopexy which is where the position of the testicles is corrected and the testicles are fixed in place or orkidectomy which is removal of the testicle and this is used if there's a delay in surgery or there's necrosis to the testicle a scrotal ultrasound scan can confirm the diagnosis however any investigation that will delay the patient going to theater for treatment is not recommended ultrasound can show the whirlpool sign which is a spiral appearance to the spermatic cord and the blood vessels if you like this video consider joining the zero to finals patreon account where you get early access to these videos before they appear on YouTube you also get access to my comprehensive course on how to learn medicine and do well in medical exams digital flash cards for rapidly testing the key facts you need for medical exams early access to the zero to finals podcast episodes and question podcasts which you can use to test your knowledge on the go thanks for watching and I'll see you in the next video