Testicular Torsion (Torsion of Spermatic Cord)

Last updated 30.06.13

 

 

Definition

-  Rotation of testicle on spermatic cord --> ischaemia +/- infarction

-  Usually rotates internally (to midline & inward)

 

Features

-  Urological (surgical) emergency

-  Delayed Dx = loss of testicle

-  Peak incidence adolescent males (13-17)

-  L > R, bilateral 2%

-  3 types

-  1 – intravaginal: most common (Bell Clapper)

-  2 – extravaginal: neonatal

-  3 – Long mesorchium: ass w cryptorchidism

-  Retorsion post orchiopexy possible

 

Types

 

Cause

-  Bell Clapper Deformity (Congenital)

-  Incomplete fusion of post attachment of testicle+ to scrotum: increased mobility of testicle

-  Cryptorchidism

-  Trauma, exercise, sex

-  Tumour

 

Assocaited S/S

-  Testicle Exam

-  Sudden onset tender, swollen, erythematous testicle

-  Exquisitely painful testicle unilateral (2% bilateral)

-   Improves when seated or testicle elevated

-  High riding testicle (ascent) or horizontal lie (50%)

-  Abdo pain 20-30%

-  Nausea & vomiting 20-30%

-  Fever 16%

-  Urinary freq 4%

-  Loss of cremasteric reflex (ipsilateral)

-  +/- prev intermittent s/s (torsion-detorsion)

 

Torsion

 

DDx

-  Torsion of Testicular Appendage

-  Pain in upper pole of testicle

-  Epididymitis, Orchitis

 

Ix

-  Doppler US if timely: vascular perfusion

-  96% spec if tech adequate scan, 94% sens

-  If no imaging available --> Surgical exploration

 

Mx

-  Antiemetics

-  Analgesia: morphine+

-  +/- manual detorsion

-  Open book technique

-  2-3 turns usually outward & lateral

-  Urgent Sx scrotal exploration

-  If well perfused: orchiopexy (should be bilateral)

-  Poorly perfused: orchiectomy

-  80-100% survival of testicle if by 6hrs

-  20% survival >10hrs

 

 

 

References