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Torsion
of the testis is seen most commonly in children and adolescents.
The predisposing factors are congenital scrotal abnormalities
which include:
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Long
mesorchium, a horizontal lie of the testis within the
scrotum |
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Ectopic
testis. |
The
presentation is one of sudden onset of lower abdominal
pain, pain in the affected testis and vomiting. The affected
testis and cord are markedly tender. The testis is often
swollen and drawn upwards. Important differential diagnoses
include:
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Epididymorchitis:
the patient often has urinary symptoms, including urethral
discharge |
| :: |
Testicular
tumour: the onset is not sudden. |
Treatment
The treatment is urgent surgery to:
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Untwist
the torsion |
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Fix
the testis |
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Explore
the other side and similarly fix the testis to prevent
the normal testis
from undergoing torsion subsequently. |
Operate on torsion of the testis without delay. Make every effort to save
the testis. Do not rush into performing orchidectomy even if, at exposure,
you think that the testis is already gangrenous. Always ask for a
second opinion in
such circumstances.
Wrap the affected testis with warm wet swabs, wait for a minimum of 5 minutes
and check for any improvement in colour. Do not hurry this stage;
give yourself plenty of time, provided you have already untwisted the torsion.
However, if the testis is dead, it should be removed, as autoimmune responses can
result in loss of function of the other testis.
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In
torsion, the testicle can
become gangrenous in 4 hours; treatment is thus an emergency
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The
non-affected side should be fixed at the same time
as the subsequent incidence of torsion
on the opposite side is high
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When
the testis is dead,
orchidectomy should be
performed to protect the other testis from loss due to
autoimmune disease
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One
testicle is enough for normal fertility.
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