If testicular torsion is strongly suspected clinically, consult. Testicular torsion is a time sensitive, surgical emergency. Diagnosis and management of testicular torsion in the emergency department. The infants testicle might be hard, swollen or a darker color. Testicular torsion is a common pediatric urologic emergency that affects 3. However, testicular torsion can be partial with some continuation of blood flow maintained. The twisting of the spermatic cord due to an anatomical abnormality that left the testis mobile and dangling in the scrotum. 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.
This is referred to as the open book maneuver, as the movement is akin to opening a book. Testicular torsion treatment algorithm bmj best practice. Testicular torsion is the sudden twisting of the spermatic cord within the scrotum. 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. The most important point in arriving at a management decision is a determination of what the scrotum looked like at birth. Torsion of the testes is a surgical emergency, since it causes strangulation of gonadal blood supply with subsequent testicular necrosis and atrophy. Testicular torsion occurs when the spermatic cord from which the testicle is suspended twists, cutting off the blood supply to the testicle. Testicular torsion is a true surgical emergency with peak presentation in adolescence, between 12 and 16 years of age. Because of the risk of ischemia and possible infarction of the testicle, it is considered a urological emergency. Partial testicular torsion and torsiondetorsion syndrome. Testicular torsion knowledge for medical students and. Critical in excluding testicular torsion may also reveal a reactive hydrocele. Testicular torsion occurs when the spermatic cord becomes twisted.
Regardless, its a very painful condition and usually warrants a trip to the emergency room. 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. 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. Color doppler ultrasonography reveals what with epididymitis.
This causes swelling and eventually cuts off the blood supply to the testicle. In other words, the affected testicle is rotated as if opening a book, hence the open book method. Testicular torsion can occur in newborns and infants, though its rare. The initial effect of testicular torsion is obstruction of venous return. The technique involves rotating the right testicle counterclockwise and the left testicle clockwise. Perinatal testicular torsion mostly occurs extravaginally in the prenatal period. Testicular torsion is an emergency condition and can threaten the. The testicle may be higher than usual in the scrotum and vomiting may occur. Each year, testicular torsion affects one in 4000 males younger than 25. Testicular torsion symptoms and causes mayo clinic. Testicular torsion is a twisting of the spermatic cord and its contents and is a surgical emergency affecting 3. Proposed score for assessing testicular torsion in children. Always perform a testicular exam in male lower abdominal pain.
The amount of twisting can be anywhere from 180720 degrees. 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. Depending on the duration and degree of cord rotation, testicular symptoms range from edema. It usually affects boys between the ages of 12 and 16, but it can happen at. Though i talk about torsion in kids here, torsion is not limited to the pediatric population. Testicular function is often compromised in patients with testicular torsion. Testis twist with inward rotation in 70% cases of testicular torsion and the. There is a slight predilection for the left testicle. In most cases, surgery is needed right away to relieve pain and swelling and to prevent the loss of the testicle. It occurs due to the rotation and twisting of the testicle. Treatment for testicular torsion is initially manual detorsion open the book followed immediately thereafter by surgical detorsion and potentially orchiectomy. 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. 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.
Hey guys, so todays lesson is about testicular torsion. The classic presentation is acute, severe scrotal pain at rest. 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. The most common symptom in children is sudden, severe testicular pain. 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. On the other hand, pubertal torsion usually occurs intravaginally and requires prompt surgical treatment. Open the book by twisting testicle outward and laterally. Recurrent testicular torsion after previous orchiopexy is rare and needs high index of suspension to avoid misdiagnosis and delayed management. This causes a restriction in blood flow to the testes, severe pain, and possibly permanent damage. Each year, testicular torsion affects one in 4,000 males younger than 25 years. This case showed that this diagnosis can occur even when the testis is still fixed to the scrotal wall. For testicular salvage, time is of the essencethe earlier the surgical intervention, the higher the likelihood of. Emergency department approach to testicular torsion. Testicular torsion is a twisting of the spermatic cord and its contents and is.
Testicular torsion is a surgical emergency with a 46hrs window from the onset of symptoms to salvage the testis before significant ischaemic damage occurs. Testicular torsion occurs when the testicle twists around the spermatic cord, resulting in blood flow to the testicle being compromised. A 31yearold male who had previous testicular fixation for testicular torsion with a single stitch to the lower pole before 6 years presented with. Open accessthis article is distributed under the terms of the creative commons. 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. Early diagnosis and definitive management are the keys to avoid testicular loss. On the third or fourth time of doing it, something weird happened and i felt a terrible pain in my abdomen. If testicular torsion goes on for more than a few hours, it can permanently damage the testicle, and a damaged testicle must be removed. With the physician facing the patient, the right testis is rotated clockwise while the left is rotated counterclockwise. Testicular torsion is a result of the twisting of the testis and spermatic cord within. 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. Newborns can get testicular torsion because the connecting tissue hasnt yet formed. Ultrasound might not detect reduced blood flow to the infants scrotum, so surgery might be needed to confirm testicular torsion.
Manual detorsion of testis in testicular torsion epomedicine. This page includes the following topics and synonyms. Testicular torsion also called testis torsion requires immediate surgery to save the testicle. If youve had testicular pain that went away without treatment intermittent torsion and detorsion, its likely to occur again. Acute scrotal swelling in children indicates torsion of the testes until proven otherwise. 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. This happens when the testicles literally twist, blocking the blood flow to one testicle. Testicular torsion is characterized by suddenonset unilateral testicular pain, which may radiate to the lower abdomen, with nausea and vomiting. Torsion of the testes is a rare event in the neonatal period, but there is controversy as to its optimal management. The age distribution of testicular torsion is bimodal, with one peak in the neonatal period and the second peak around puberty.
Rotate affected testicle as if opening a book medial torsion. Testicular torsion is a clinical diagnosis and the primary goal is surgical detorsion in the operating room. The doctor will examine the scrotum, testicles, abdomen, and groin and. 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. Should manual detorsion be a routine part of treatment in testicular. Testicular torsion diagnosis and treatment mayo clinic. Common testicular problems and what to do about them. For the best results, surgery should be done within 4 hours after symptoms begin. Then, the next one 180 degree twist will be hard, and will go back where that half turn started.
Herein, we describe a case report involving testicular torsion in a rarely seen age group. Testicular torsion is something that 1 in 4000 men under the age of 25 experience every year. Testicular torsion typically presents with acute or insidious onset of excruciating, usually unilateral testicular andor scrotal 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. Pediatric testicular torsion is an acute vascular event in which the spermatic cord becomes twisted on its axis see the image below, so that the blood flow to or from the testicle becomes impeded.