testicular torsion
| Headline | |
|---|---|
| Etiology | twisting on spermatic cord → ischaemia +/- necrosis. |
| Epidemiology | Risk factors: bell clapper deformity; trauma |
| Clinical presentation | Sudden onset severe unilateral testicular pain High riding testicle with horizontal lie; blue dot sign Prehn's sign: ↑ pain with elevation of scrotum - does not rule out |
| Pathogenesis | |
| Diagnostic investigations | Some people might ask for an ultrasound. Perhaps it is merely delaying the inevitable: surgical exploration. ddx: epididymo-orchitis |
| Management | surgical exploration → orchiectomy vs orchidopexy depending on extent of tissue damage |
TWIST (Testicular Workup for Ischemia and Suspected Torsion) Score
Proposed score for assessing testicular torsion in patients < 18 years of age (Barbosa 2013) and (Frohlich 2017)
| Finding | Points |
|---|---|
| Testicular swelling | 2 |
| Hard testicle | 2 |
| Absent cremasteric reflex | 1 |
| Nausea or vomiting | 1 |
| High-riding testicle | 1 |
- PPV 100% when 7 points
- NPV 96% when <5 points
- likely rule in rather than rule out
sources/links
https://www.rcemlearning.co.uk/modules/testicular-torsion/
https://www.rcemlearning.co.uk/reference/testicular-pain/#1571735808364-6b067a62-b8dd (this is really good re clinical presentation especially )