Testicular Torsion

Torsion of Testis ByGaurav Jadhav. Vaibhav Devkar.

Torsion of Testis Torsion 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 Factors a) Inversion of testis b) 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.

Pathology Spasm of cremaster muscle is main initiating factor. Torsion usually occurs from without inwards, i.e. -left testicle rotates-anti clockwise -right testicle rotates- clockwise In torsion along with vascular occlusion there is oedema of testis and chord which gradually leads to gangrene of testis and epididymis.

History • 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

Symptoms • 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.

Examination • LOCAL The 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.

Examination Other examination It 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 Diagnosis Two main D/d are • Acute epididymo-orchitis- in c/o torsion of completely descended testis. Epididymitis is unusual before age of 24 yrs. • Strangulated inguinal hernia- in c/o torsion of incompletely descended testis.

Diagnosis Doppler 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.

Treatment If the pt. comes earlyManual 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 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 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 anatomy

Torsion of left testicle

Surgical Correction

Prognosis If detorsion done within 12 hrsgood result with 100% success. If detorsion is done from 12 to 24 hrs-recovery possible in majority of cases.

Prognosis 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.