The P.A. Pulse – Testicular Torsion

 

 

Testicular torsion the most common pediatric emergency of the genitourinary tract. It occurs when the spermatic cord that holds the testicle gets twisted. The spermatic cord contains blood vessels and passageways for sperm, and when it is twisted, blood flow to the testicle is reduced or blocked. The reduced blood flow causes sudden and often severe pain and swelling. If the blood supply is cut off for too long then the testicle will suffer permanent damage. This condition usually happens to only one testicle, but can happen to both. It usually affects babies up to 1 year of age and children 12 to 18 years of age.

Symptoms

  • Testicular pain  (acute onset or intermittent)
  • Swollen, red, tender scrotum
  • Enlarged testicle
  • Abnormal position of testicle (testicles that appear to hang a bit higher than usual)
  • Fever
  • Abdominal pain
  • Nausea or vomiting

Symptoms in newborns

    • Possible absent testicle
    • Firm, painless scrotal mass – either enlarged or atrophied
    • Possible acute inflammation – swollen, erythematous or blue discolored in venous engorgement and tender hemi-scrotum

Testicular torsion should always be suspected in a male patient with severe, sudden-onset testicular pain. The most important thing to know about testicular torsion is that it is an emergency that must be treated immediately.

The time from the start of symptoms until treatment is the most important factor in being able to save the testicle. The longer someone waits to seek treatment, the greater the risk of permanent injury.

  • If treated within 6 hours of the start of pain, there is more than a 90% chance of saving the testicle.
  • If treated after 24 hours of pain, there is less than 10% chance of saving the testicle.

Treatment

  • Testicular torsion is a medical emergency and should be treated upon suspicion within 6 hours of the onset of symptoms to prevent loss of the testis.
  • Immediate surgical exploration of the testicle with reduction (untwisting) and orchidopexy
  • Orchidopexy (fixation) of the contralateral side is recommended
  • Manual detorsion may be attempted to possibly buy time and relieve symptoms, but is not a replacement for surgical exploration
    • If surgery is not possible within the recommended window of intervention:
      • Trial of conservative maneuver: turn the testicle towards the lateral direction (left testicle → clockwise; right testicle → counterclockwise).
      • Still perform surgical exploration as a trial of treatment when outside the preferred window of treatment

Because of the risk of significant consequences for (often young) patients, surgical exploration of the testicle is recommended in cases of suspected testicular torsion.

2018-09-12T09:55:35+00:00 September 12th, 2018|Uncategorized|0 Comments

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