Torsion Of Testis / Testicular Torsion

It is the torsion of the spermatic cord structures and subsequent loss of the blood supply to the ipsilateral testicle.

This is a urological emergency

Causes Of Testicular Torsion

  1. Physical activity
  2. Injury to the scrotum
  3. Cold temperatures
  4. Rapid growth of testis during puberty
  5. Straining during defecation 
  6. Coitus
  7. During sleep 



Management Of Torsion Of Testis

Presentation

  1. Age 10 – 25 years
  2. Sudden agonizing pain in groin and lower abdomen
  3. Nausea and vomiting
  4. Swelling of the scrotum
 
Examination
  1. Mild pyrexia
  2. Redness of the overlying skin 
  3. Extreme tenderness of the testis
  4. High riding of the testis
  5. Elevation of the testis make the pain worse
  6. Abnormal angle of the testis (Transverse)
  7. Tender, twisted and thickened cord
  8. Loss of cremasteric reflex 
 
Investigations
  • Usually no investigations are needed
  • Clinical diagnosis is done
  • If any uncertainty – Doppler ultrasonography
 
Treatment
  1. Surgical exploration 
    • If viable – 3 point fixation 
    • If non viable – Orchidectomy 
 
Complications Of Torsion Of Testis
  1. Testicular infarction 
  2. Scrotal abscess
  3. Gangrene of the testes
  4. Necrosis 
  5. Recurrence 
 
 
Difference Between Testicular Torsion And Acute Epididymo-orchitis
 
Traits
Torsion Of Testis
Acute Epididymo-orchitis
History
1. Age Young age Any age
2. Onset Sudden Gradual
3. History of staining Present Absent
4. History of UTI Absent Present
Examination
1. Signs of inflammation Absent unless gangrene Present
2. Position of testis High up Normal
3. Effect of elevation Aggregates of pain Relieves pain
4. Site Unilateral May be bilateral
5. Fever Absent unless gangrene Present
Investigations
1. Leukocytosis Absent unless gangrene Present
Treatment Surgical Conservative
 
 
Contents Of Spermatic Cord
  1.  Arteries
    • Testicular artery
    • Deferential artery
    • Cremasteric artery
  2. Nerves
    • Nerve to cremaster
    • Testicular nerves 
  3. Vas deferens (ductus deferens)
  4. Pampiniform plexus
  5. Lymphatic vessels
  6. Tunica vaginalis (remains of the processus vaginalis)
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