testicular torsion

Torsion ofTorsion ofTestis Testis

By-By-Gaurav Jadhav. Gaurav Jadhav. Vaibhav Devkar.Vaibhav Devkar.

Torsion of TestisTorsion of TestisTorsion of testicles is an uncommon

condition which is limited to peripubertal males.

It causes strangulation of blood supply to testis and unless treated within 3 to 4 hrs, testicular atrophy is inevitable.

Predisposing FactorsPredisposing Factorsa) Inversion of testisb) Long mesorchium-in this case

torsion of testis takes place without torsion of spermatic chord.

c) Undescended and ectopic testis.d) Voluminous tunica vaginalis-gives

adequate space to testis to rotate.

PathologyPathologySpasm of cremaster muscle is main

initiating factor.Torsion usually occurs from without

inwards, i.e.-left testicle rotates-anti clockwise-right testicle rotates- clockwiseIn torsion along with vascular occlusion

there is oedema of testis and chord which gradually leads to gangrene of testis and epididymis.

HistoryHistory• The patient's history often indicates

recent hard physical work, vigorous exercise, or trauma to the genital area; however, testicular torsion can also occur without any apparent reason

SymptomsSymptoms• Severe pain in one testicle or in groin

region.• Pain is sudden and agonizing; often

referred to lower abdomen.• Other symptoms may include swelling of

the scrotum, blood in the semen, nausea and vomiting, and fever.

• A few patients feel the need to urinate frequently.

ExaminationExamination• LOCALThe affected testicle is swollen and

tender. It usually lies higher in the scrotum

than the unaffected testicle and may be lying in a horizontal position.

The scrotum may be normal or red and oedematous.

ExaminationExaminationOther examinationIt is difficult to differentiate testicular

torsion from epididymo-orchitis.Elevation of scrotum relieves pain in

epididymo-orchitis, but increases in torsion of testis and spermatic chord.

Differential DiagnosisDifferential DiagnosisTwo main D/d are i) Acute epididymo-orchitis- in c/o

torsion of completely descended testis. Epididymitis is unusual before age of 24 yrs.

ii) Strangulated inguinal hernia- in c/o torsion of incompletely descended testis.

DiagnosisDiagnosisDoppler stethoscope in conjugation

with ultrasound is simple test to diagnose this condition.

Testis which is made ischaemic with torsion will not echo sound; while hypervascularised epididymis will increase sound.

TreatmentTreatmentIf the pt. comes early- Manual Detorsion may be tried.If detorsion is successful surgical

fixation can be done within few days; if it fails -immediate surgical exploration should be performed.

Surgical procedureSurgical procedure• The surgeon makes an incision in

the patient's scrotum and untwists the spermatic cord.

• The affected testicle is inspected for signs of necrosis, or tissue death.

• If too much tissue has died due to loss of blood supply, the surgeon will remove the entire testicle.

Surgical procedureSurgical procedure• If the tissue appears to be healthy,

the surgeon sutures the testicle to the wall of the scrotum and then closes the incision.

• In most cases, the surgeon will also attach the unaffected testicle to the scrotal wall as a preventive measure.

Normal anatomyNormal anatomy

Torsion of left testicleTorsion of left testicle

Surgical CorrectionSurgical Correction

PrognosisPrognosis

If detorsion done within 12 hrs-good result with 100% success.

If detorsion is done from 12 to 24 hrs-recovery possible in majority of cases.

PrognosisPrognosis

Detorsion can be advised even from 24 to 36 hrs-but preservation is doubtful.

If case is delayed by more than 48 hrs-orchidectomy is more advisable than detorsion operation.