naser moradi md assistant professor in urology. normal bell – clapper deformity appendages :...
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Naser Moradi MDAssistant professor in Urology
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NormalBell – clapper deformityAppendages : testis ( Mulerian )
Epididymis ( Wolfian )
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1/4000 males < 25 yr.s old
Perinatal # 10% ( 70% prenatal )Peripubertal ( 12 – 20 yr.s old )Ages 4 to 6 yr.s ( hyperactive
cremaster )
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Increase of testis volume ( puberty , tumor )
Bell – clapper deformityUDT ( intra abdominal )Activity of cremaster muscle
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Torsion of appendix testisTorsion of appendix epididymisEpididymitisEpididymo-orchitisInguinal hernia TraumaInsect biteTestis tumorSkin diseases
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Melekos (1988) : 100 children < 15 yr.s
42% Testis torsion 32% appendages torsion ****************************** 16% testis torsion 46% appendix torsion 35% other causes
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Torsion of undescended testis in a baby receiving hormonal therapy (1993).
Reigler (1972) : 64% of torsed UDTs in adults had tumors.
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1.Extravaginal
2.Intravaginal
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1, Pain : acute scrotal (90%)2, pain : inguinal & lower abdomen3, Nausea & vomiting (40%)4, Acute abdomen5, previous similar history (36%)6, Usually occurring at rest (4%
previous trauma & 10% after exercise )
7, Usually no urinary symptom ( < 5% )
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1, Oedema & erythema of hemiscrotum2, high riding testis : tender ,
firm ,horizontal3, Epididymis not palpable or dislocated4, Fixed testis (no free movement)5, Cremasteric reflex : absent6, Prehn,s sign : negative7, No fever / leukocytosis
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1, Extravaginal2, Nontender firm testis3, No erythema / oedema of scrotum4, Discolored scrotum fixed to testis5, Testis is almost always necrotic6, Neonatal operation (inguinal) : ?
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*** History & age*** Physical exam*** Absent cremasteric reflex Color doppler ultrasonography : sensitivity 90% specificity 99% false positive 1% Lab. Exams : CBC & U/A Isotope scan *** Surgical exploration
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Blood vessels obstruction 6 hours => death of sertoli & spermatogenic cells
10 hours=> death of Leydig cells
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Severe atrophy of testis has been seen with “4 hours “ of ischemia
In general : Testis atrophy is uncommon if torsion is treated up to 8 hours of onset of symptoms
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Manual detorsionEmergency surgical exploration Bilateral orchiopexy