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Testicular Torsion

Definition
  • Testicular torsion: Twisting of the spermatic cord leading to impaired blood flow to the testicle, resulting in ischaemia.
Epidemiology
  • Most common in neonates and adolescents.
  • Peak incidence: puberty (12-18 years).
Aetiology & Risk Factors
  • Believed torsion: Anatomical abnormality where the testes are more mobile within the scrotum.
  • Testicular trauma or rapid growth during puberty.
  • Previous torsion event that resolved spontaneously.
Clinical Presentation
  • Sudden, severe testicular pain, often unilateral.
  • Associated nausea and vomiting.
  • Swollen, erythematous and tender testicle.
  • High-riding testicle and horizontal lie on examination.
  • Absent cremasteric reflex on the affected side.
Investigations
  • Colour Doppler ultrasound: Decreased or absent blood flow in the affected testicle.
  • Immediate surgical exploration is indicated in suspected cases without waiting for imaging.
Management
  • Emergency surgical detorsion and fixation, ideally within 6 hours to preserve testicular viability.
  • Contralateral testicular fixation due to risk of torsion in the other testicle.
  • If necrosis is present, orchiectomy (testicle removal) is performed.
Complications
  • Testicular infarction and atrophy.
  • Infertility if bilateral torsion or subsequent torsion of the contralateral testicle occurs.

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