In an easy to understand language, the experienced health author dr. Diagnosis and management of testicular torsion in the emergency department. Neonatal testicular torsion, also known as perinatal testicular torsion is a subject of debate among surgeons. Manual detorsion of testis in testicular torsion epomedicine. Treatment for testicular torsion is initially manual detorsion open the book followed immediately thereafter by surgical detorsion and potentially orchiectomy. Testicular torsion tt is a true urologic emergency and must be differentiated from other causes of acute testicular pain because a delay in diagnosis and management can lead to loss of the testis and infertility. Testicular torsion is a surgical emergency with a 46hrs window from the onset of symptoms to salvage the testis before significant ischaemic damage occurs. Torsion of the testes is a rare event in the neonatal period, but there is controversy as to its optimal management. Rotate affected testicle as if opening a book medial torsion. Testicular torsion is characterized by suddenonset unilateral testicular pain, which may radiate to the lower abdomen, with nausea and vomiting. This happens when the testicles literally twist, blocking the blood flow to one testicle. It usually affects boys between the ages of 12 and 16, but it can happen at.
The doctor will examine the scrotum, testicles, abdomen, and groin and. Newborns can get testicular torsion because the connecting tissue hasnt yet formed. Herein, we describe a case report involving testicular torsion in a rarely seen age group. Open accessthis article is distributed under the terms of the creative commons. Always perform a testicular exam in male lower abdominal pain. Consider occult testicular torsion if undescended testicle especially in infants with unconsolable crying lower abdominal pain without testicular pain may be the only presenting symptom of testicular torsion in 30% of cases. Testicular torsion is a result of the twisting of the testis and spermatic cord within. Each year, testicular torsion affects one in 4000 males younger than 25. Testicular torsion is a twisting of the spermatic cord and its contents and is. There is a slight predilection for the left testicle. Testicular torsion is something that 1 in 4000 men under the age of 25 experience every year. This causes swelling and eventually cuts off the blood supply to the testicle.
I was at wrestling camp doing a move that involved you putting the other guys leg between yours and then kinda throwing him over your shoulder. Open the book by twisting testicle outward and laterally grasping testicle with thumb and forefinger, rotate 180 degrees in medial to lateral direction repeat rotation 2 3 times until testicle is detorsed and pain decreases if pain is worse after rotation or if rotation is not successful, attempt to rotate testicle in opposite direction. The degree of cord twisting and the time between onset of symptoms and detorsion are most important factors to decide early salvage rate of the testis. The amount of twisting can be anywhere from 180720 degrees. Any suspected case warrants urgent surgical exploration of the testis to assess the testes and the spermatic cord for evidence of torsion. The more frequent the bouts of pain, the higher the risk of testicular damage.
Depending on the duration and degree of cord rotation, testicular symptoms range from edema. Critical in excluding testicular torsion may also reveal a reactive hydrocele. If youve had testicular pain that went away without treatment intermittent torsion and detorsion, its likely to occur again. Each year, testicular torsion affects one in 4,000 males younger than 25 years. Testicular torsion is a clinical diagnosis and the primary goal is surgical detorsion in the operating room. Common testicular problems and what to do about them. Open the book by twisting testicle outward and laterally. With the physician facing the patient, the right testis is rotated clockwise while the left is rotated counterclockwise.
Testicular torsion can occur in newborns and infants, though its rare. Should manual detorsion be a routine part of treatment in testicular. Testicular torsion is most common between ages 12 and 18. Color doppler ultrasonography reveals what with epididymitis. Testicular torsion is a time sensitive, surgical emergency. The most common symptom in children is sudden, severe testicular pain.
Testicular torsion is the sudden twisting of the spermatic cord within the scrotum. Acute scrotal swelling in children indicates torsion of the testes until proven otherwise. The age distribution of testicular torsion is bimodal, with one peak in the neonatal period and the second peak around puberty. This is referred to as the open book maneuver, as the movement is akin to opening a book. In other words, the affected testicle is rotated as if opening a book, hence the open book method. On the third or fourth time of doing it, something weird happened and i felt a terrible pain in my abdomen. The infants testicle might be hard, swollen or a darker color. Testicular torsion also called testis torsion requires immediate surgery to save the testicle. Regardless, its a very painful condition and usually warrants a trip to the emergency room. Acute scrotal painswelling or intermittent testicular pain testicular tenderness highriding testis with horizontal lie absent cremasteric reflex on the affected side negative prehn sign no relief of pain upon elevation of the testis manual detorsion may serve as a temporizing measure to reperfuse the testis while the patient is. It occurs due to the rotation and twisting of the testicle. Emergency department approach to testicular torsion. A 31yearold male who had previous testicular fixation for testicular torsion with a single stitch to the lower pole before 6 years presented with.
For testicular salvage, time is of the essencethe earlier the surgical intervention, the higher the likelihood of. Neonatal testicular torsion either intrauterine or postnatal results into extravaginal torsion which is a different entity than intravaginal type but has the same devastating consequences if not diagnosed and managed well in time. Hey guys, so todays lesson is about testicular torsion. Testis twist with inward rotation in 70% cases of testicular torsion and the. Testicular torsion occurs when the testicle twists around the spermatic cord, resulting in blood flow to the testicle being compromised. The initial effect of testicular torsion is obstruction of venous return. Testicular torsion symptoms and causes mayo clinic. If it is truly a torsion, you will have one or more 180 degree rotations that are easy. If testicular torsion is strongly suspected clinically, consult. Testicular torsion is a true surgical emergency with peak presentation in adolescence, between 12 and 16 years of age. Partial testicular torsion and torsiondetorsion syndrome. The twisting of the spermatic cord due to an anatomical abnormality that left the testis mobile and dangling in the scrotum.
In this surgery orchiopexy, a urologist will open the scrotum, untwist the testicle, and then fix it in place to prevent rotation in the future 5. Testicular function is often compromised in patients with testicular torsion. You will ultimately need surgery to fix testicular torsion because there still might be some residual twisting and there is a high probability that the torsion will occur again. Testicular torsion occurs when the spermatic cord from which the testicle is suspended twists, cutting off the blood supply to the testicle.
Proposed score for assessing testicular torsion in children. The technique involves rotating the right testicle counterclockwise and the left testicle clockwise. As the most common cause of scrotal pain in children, torsion of the appendix testis can present with clinical features similar to testicular torsion, such as severe acute scrotal pain with nausea and vomiting. Testicular torsion is a twisting of the spermatic cord and its contents and is a surgical emergency affecting 3. This causes a restriction in blood flow to the testes, severe pain, and possibly permanent damage. This case showed that this diagnosis can occur even when the testis is still fixed to the scrotal wall. Open the book by twisting testicle outward and laterally grasping testicle with thumb and forefinger, rotate 180 degrees in medial to lateral direction repeat rotation 2 3 times until testicle is detorsed and pain decreases. Testicular torsion diagnosis and treatment mayo clinic. Testicular torsion knowledge for medical students and. The testicle may be higher than usual in the scrotum and vomiting may occur. Ultrasound might not detect reduced blood flow to the infants scrotum, so surgery might be needed to confirm testicular torsion. This is a urologic emergency that affects one in 4000 males younger than 25 years annually and results in an orchiectomy 42% of the time in those undergoing surgery for testicular torsion. Hansen explains the symptoms, causes, diagnoses, and effective treatments of the most common testicle health problems such as testicular pain, swelling, trauma, infection, testicular torsion, lumps, cysts, spermatocele, varicocele, hernia, and testicular cancer. Manual detorsion is not recommended for torsion of duration 68 hours prolonged ischemia leads to marked swelling and edema after which manual detorsion is not effective manual detorsion should not delay scrotal exploration and bilateral orchipexy in the operating room.
The most important point in arriving at a management decision is a determination of what the scrotum looked like at birth. Testicular torsion is a common pediatric urologic emergency that affects 3. Testicular torsion is an emergency condition and can threaten the. Testicular torsion treatment algorithm bmj best practice. Testicular torsion typically presents with acute or insidious onset of excruciating, usually unilateral testicular andor scrotal pain. Testicular torsion occurs when the spermatic cord becomes twisted. The classic presentation is acute, severe scrotal pain at rest. Though i talk about torsion in kids here, torsion is not limited to the pediatric population. By the end of the lesson, you will have a better understanding of what testicular torsion is, different causes, assessment findings, diagnostics, therapeutic management, and nursing considerations when caring for these patients. Recurrent testicular torsion after previous orchiopexy is rare and needs high index of suspension to avoid misdiagnosis and delayed management. Then, the next one 180 degree twist will be hard, and will go back where that half turn started. Because of the risk of ischemia and possible infarction of the testicle, it is considered a urological emergency. However, testicular torsion can be partial with some continuation of blood flow maintained.
Perinatal testicular torsion mostly occurs extravaginally in the prenatal period. Early diagnosis and definitive management are the keys to avoid testicular loss. This page includes the following topics and synonyms. In most cases, surgery is needed right away to relieve pain and swelling and to prevent the loss of the testicle. On the other hand, pubertal torsion usually occurs intravaginally and requires prompt surgical treatment. In terms of highest incidence, testicular torsion is more likely in the first year of life and during puberty, whereas epididymitis is more prevalent in adulthood.
384 146 143 239 758 623 50 1450 28 377 927 827 1435 784 1467 559 1191 874 135 1331 366 1103 1307 29 857 32 144 1453 923 351 538 641 792 891 1139 546