Introducing
Your new presentation assistant.
Refine, enhance, and tailor your content, source relevant images, and edit visuals quicker than ever before.
Trending searches
Testicular Torsion
1
Testicular Torsion
Richard Bramley
Aetiology
Testicular torsion occurs when there is mechanical twisting of the spermatic cord, which suspends the testicle within the scrotum and contains the testicular artery and vein.
Twisting of the cord reduces or eliminates blood flow to the testicle.
Typically, venous blood flow is compromised first. The increase in venous pressure subsequently causes decreased arterial blood flow, leading to decreased oxygen supply to the testicle, and if untreated, testicular infarction.
Most Common Causes
Most Common Causes
1. Bell clapper deformity
- men and boys born with weaker connective tissue in the scrotum so the testicles move freely
- increases the risk of the spermatic cord to get twisted
- occurs in about 17% of males and 40% are bilateral
2. Injury to groin
- sudden trauma or contact sports injuries to the groin region
- men can wear a cup to prevent injury in sports
- can happen spontaneously during sleep
3. Rapid growth during puberty
Pathophysiology
Pathophysiology
- Intermittent testicular torsion
- Extravaginal testicular torsion
- Intravaginal testicular torsion
- Torsion of the testicular appendix
- Torsion of the undescended testicle
Signs & Symptoms
Symptoms are usually very severe and emergency treatment is required
Most commonly found in the ages of 12-18 years old
Affects ~1/4000 males before the age of 25
Signs
Signs
Signs include the following:
- Swelling of the scrotum
- Pain in scrotum
- Pain in abdomen
- One testicle hanging higher than the other
- Reddening of affected testicle
Symptoms
Symptoms
Pain and swelling of the scrotal sac are most common symptoms
- swelling can occur on one side or the entire scrotum
Other Symptoms include:
- Dizziness
- Nausea
- Vomiting
- Lumps in the scrotal sac
- Blood in the semen
- Painful urination
- Fever
Diagnosis & Treatment
Quick diagnosis is vital to preserving a testicle
< 6 hours: good prognosis
> 12 hours: 75% chance of losing testicle
Diagnosis & Treatment
Diagnosis
Clinical Exam:
Doctor will assess the common areas; scrotum, abdomen, testicles, & groin
Most common diagnostic test: pinching inside of thigh on affected side.
- No testicular contraction = testicular torsion
Urinanalysis
Imaging:
- Doppler ultrasound
- Scrotal scintigraphy
Treatment
Emergency surgery
Surgeon will untwist spermatic cord to allow for proper blood flow. Orchiopexy surgery will prevent recurrence.
If the testicle dies, it must be removed to prevent gangrenous infection (orchiectomy)
Post surgery: Patient is to avoid strenuous and sexual activity for a few weeks minimum
Phosphodiesterase inhibitors?