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Etiology

Testicular torsion is the sudden twisting/rotation of the spermatic cord within the scrotum (Urosurgical emergency!)
This condition is idiopathic but is associated with a poorly secured testis (congenital inadequate fixation of testis to tunica vaginalis)
This condition usually affects neonates (first 30 days of life) and young adults (10-18 years)
It occurs as a result of vigorous physical activity (inciting event) or trauma (in very rare cases)
If testicular torsion is suspected, immediate surgical exploration is warranted within 6 hours of symptom onset (to salvage the testis)
Orchiopexy, when performed, should be bilateral because the contralateral testis is at risk for subsequent torsion

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Clinical features

Testicular torsion is characterised by acute, severe testicular pain (scrotal, inguinal or lower abdominal)
Abnormal position of the a swollen tender testis (scrotal elevation/high-riding testis or abnormal horizontal position)
Nausea and vomiting
Absent cremasteric reflex
Negative Prehn sign

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Testicular torsion is typically a clinical diagnosis (definitive treatment should not be delayed for diagnostic work up if clinical suspicion is high)
Duplex ultrasound of the scrotum (enlarged testis, twisting of spermatic cord, reduced or absent blood flow)

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Testicular salvage rates depends on the internal of time between symptom and restoration of testicular blood flow
If it was restored within 6 hours: 90-100%
If it was restored over 12 hours: 20-60%
If it was restored over 24 hours: 20%

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اشترك للوصول لفيديوهات الشرح التفصيلي والبطاقات التعليمية التفاعلية وأسئلة الممارسة مع تتبع التقدم.

فيديوهات الشرح بطاقات تفاعلية أسئلة ممارسة