Testicular Torsion

Original article by Ciaran de Souza | Last updated on 7/6/2014
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Definition

This is when the spermatic cord (contains the vas deferens, lymphatic vessels, testicular artery, cremasteric artery, panpiniform plexus (veins), nerve to cremaster, testicular nerves) to a testicle twists therefore cutting off the blood supply to the testicle. This is due to a mechanical twisting process which can lead to testicular death. It is a MEDICAL EMERGENCY.

 

Epidemiology

Can occur at any age but most frequently among neonates and adolescents. It is rare >30 years of age. It occurs in about 1 in 160 males per year.
 

Risk Factors

  • Bell-clapper deformity (this is where the testicle has formed with no attachment to its surrounding scrotal walls and so is free floating within the tunica vaginalis – the serous sac surrounding the testicle)
  • Large size – either normal variation or the presence of a tumour
  • Sudden change in temperature from hot to cold causing sudden scrotal contraction which can trap the testicle in a rotated position
  • An undescended testis
  • Previous testicular pain
 

Differential Diagnosis

  • Epididymitis (main differential)
  • Epididymo-orchitis
  • Scrotal oedema
  • Incarcerated inguinal hernia
 

Presentation

  • Acute onset of diffuse pain – can be in the scrotum, groin, lower abdomen or the inguinal region.
  • Swollen testis
  • Testicular tenderness
  • Fever
  • Nausea
  • Vomiting
 

Investigations

  • Doppler Ultrasound Scan can be done to look at the flow of testicular blood – this helps to rule out epididymitis where the flow will be present. In torsion, there will be absent blood flow.
  • Cremasteric reflexshould be absent in true torsion but may only be diminished so this is not an accurate investigation.
  • Surgical exploration is mandatory unless torsion can be excluded.
 

Treatment

  • Surgical emergency– immediate intervention required to detort the testis.
 

Prognosis

  • If treated within 6 hours – 90% chance of survival of the testicle surviving; 12 hours – 50%; 24 hours – 10%; >24 hours – 0%.