Testicular torsion

NormalTesticle Vs Testicular Torsion

it is a urological emergency caused by the twisting of the spermatic cord and the blood supply to the testicle causing ischemic damage to the testis.

Testicular torsion is the most common cause of testicular loss in adolescents and neonates. However, torsion may occur in men 40-50 years old.

Role Of "6 Golden Hours": 

Twisting of the testicle causes venous occlusion and arterial ischemia and infarction. The degree of torsion the testicle not managed and treated may play a role in the viability of the testicle over time. Testicular viability decreases significantly after 6 hours from onset of symptoms so diagnostic testing should not delay treatment or Surgical Intervention.

Diagnosis of testicular torsion is clinical: Don't wait for investigations.

The tunica vaginalis attachment: is normally to the posterolateral aspect of the testicle, at which the spermatic cord is not very mobile.

Bell clapper deformity: it is the deformity at which the attachment of the tunica vaginalis to the testicle is abnormally high so the spermatic cord can rotate within it, which may lead to intravaginal torsion.

Intravaginal torsion :

occurs due to Bell Clapper Deformity and due to inappropriate high attachment of the tunica vaginalis to the testicle.

Most Common in adolescents.

Extravaginal torsion: 

Most Common in neonates.

The tunica vaginalis is not attached to the gubernaculum so the spermatic cord and the tunica vaginalis undergo torsion as one unit.

Note: Testicular torsion may be associated with testicular malignancy, especially in adults.

Symptoms and Signs:

Acute Pain and Tenderness.

Absent Cremasteric Reflex.

Scrotal Oedema.

Horisontal Lie Of The Testis.

Scrotal Erythema.

Hard Testis.

Abdominal Pain.

Nausea and Vomiting.

Groin Pain.

Treatment: by Urgent Exploration untie the Twist and Orchiopexy.