TORSION OF TESTIS
By: BOYEKA JORDY
OUTLINE
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▪ Introduction
▪ Defintion
▪ Epidemiology
▪ Aetiology
▪ Pathophysiology
▪ Risk factors
▪ Clinical manifestations
▪ Differential diagnoses
▪ Evaluation of Acute Scrotum
▪ Management
▪ Complications
▪ References
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INTRODUCTION
▪ Testicular torsion occurs when the testicles rotates on the
spermatic cord, which brings blood to the testicucle from the
abdomlen.
▪ If the testicles roates several times, blood flow to it can be
entirely blocked, causing damage more quickly.
▪ If left untreated the blood flow to the testicle ceases and the
testicle dies.
▪ Testicular torsion is therefore a surgical emergency and the
earlier the surgery to untwist the testis can be undertaken the
better the outcome.
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DEFINITION
▪ Torsion of testis is a condition whereby the
testicle twists in such a way that its blood
supply becomes compromised.
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EPIDEMIOLOGY
▪ Testicular torsion occurs in all age groups, but it most
commonly occurs after birth and between 12 and 18 years
of age.
▪ The incidence is estimated to be 1 in 4000 males below the
age of and another study found an annual incidence of 3.8
per 100,000 males <18 years
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AETIOLOGY
▪ Clapper deformity
▪ Infections
▪ Cold temperature exposure
▪ Testicular tumors or masses
▪ Testicular anomalies (cryptorchidism or high-riding testicle)
▪ Testicular injury or trauma
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PATHOPHYSIOLOGY
Torsion of the testis is uncommon because the normal testis is anchored and
cannot rotate. For it to occur one of several abnormalities must be present:
▪ High investment of the tunica vaginalis causes the testis to hang within the
tunica like a clapper in a bell. This is the most common cause in adolescents
and is typically a bilateral abnormality.
▪ Inversion of the testis. The testis is rotated so that it lies transversely or upside
down.
▪ Separation of the epididymis from the body of the testis permits torsion of the
testis on the pedicle that connects the testis with the epididymis
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PATHOPHYSIOLOGY (cont’d)
▪ Normally, when there is a contraction of the abdominal muscles, the
cremaster contracts as well.
▪ In the presence of one of the abnormalities described earlier, the spiral
attachment of the cremaster favors rotation of the testis around the vertical
axis.
▪ Sudden contraction of the cremasteric muscle, which may be a response to
mechanical, sexual or thermic stimulation, may cause a rotational effect on
the testis as it is pulled upward.
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RISK FACTORS
▪ Age (12-18)
▪ Previous occurrence
▪ Anatomical predisposition
▪ Testicular tumors
▪ Testicular anomalies
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CLINICAL MANIFESTATIONS
▪ Sudden agonizing pain in the groin and the lower
abdomen
▪ Nausea and vomiting
▪ Swollen and tender scrotum (complete torsion)
▪ Loss cremasteric reflex
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DIFFERENTIAL DIAGNOSES
▪ Epididymo-orchitis
▪ Mumps orchitis
▪ Idiopathic scrotal oedema
▪ Strangulated inguinal hernia
EVALUATION OF THE ACUTE SCROTUM
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MANAGEMENT
INVESTIGATIONS
▪ Urinalysis to rule out urinary tract infections or other genitourinary
conditions that can present with similar symptoms to testicular torsion
▪ Blood Tests, including complete blood count (CBC) and serum
biomarkers such as lactate dehydrogenase (LDH) and creatine kinase
(CK). Elevated levels of LDH and CK can indicate testicular ischemia
and necrosis
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MANAGEMENT (cont’d)
TREATMENT
➢Pharmacologic
▪ Antibiotics
▪ Anti-inflammatories
▪ Analgesics
MANAGEMENT (cont’d)
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➢ Surgical treatment
▪ scrotal exploration
o Transverse scrotal incision to expose the scrotal structures.
o If the testis if found viable when the cord is untwisted, fixation with
3 non-absorbable sutures between the tunica albuginea of the testis
and the scrotal raphe is done to prevent twisting reocurence.
o If there is doubt about testicular viability after detorsion of the testis,
then it should be wrapped in a warm swab and observed over a few
minutes. If a small incision in the tunica albuginea demonstrates
bright red arterial bleeding then the testis may survive.
o An infarcted testis should be removed, the patient can be counselled
later about a prosthetic replacement.
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COMPLICATIONS
▪ Infertility
▪ Reduced testosterone production
▪ Infections (bacterial or surgical)
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REFERENCES
▪ High risk and low prevalence diseases:
Testicular torsion
▪ Bailey & Love's Essential Clinical anatomy
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THANKS FOR LISTENING
