Testicular torsion

Introduction

Testicular torsion or torsion of the testis is twisting of the spermatic cord with
compromise of the blood supply to the testis.
It is an uncommon affliction that is most
commonly seen in adolescent males.
A few cases occur in infancy.

Symptoms and clinical features of torsion of the testis

  1. Pain in one testicle: of sudden onset, severe and radiates to the lower abdomen
  2. Nausea and vomiting
  3. Swollen, high lying testis with reddening of the scrotal skin
  4. Tenderness. Pain can be increased by lifting
  5. Absence of the cremasteric reflex
  6. Abnormal lie of the testis on the opposite side

Differential diagnoses

  • Acute epididymo-orchitis
  • Mumps orchitis
  • Trauma to the testis
  • Insect bites
  • Inflammatory vasculitis (Henoch-Schonlein purpura)
  • Strangulated inguinal hernia
  • Testicular tumour
  • Idiopathic scrotal oedema
  • Fournier’s gangrene

Complications of Testicular torsion

  • Testicular atrophy
  • Sympathetic orchidopathy
  • Abnormal sperm count
  • Infertility

Investigations

Colour Doppler sonography

  • An absence of arterial flow is typical

Radionuclide scan using Tc-99m
pertechnetate

  • The twisted testis is avascular

Treatment for testicular torsion

Treatment objectives

  • Detorsion
  • Fixation of the testis to prevent recurrence

Non Treatment

  • Fixation on the affected side and prophylactic fixation on the opposite side