Torsion of

Torsion of
Testis
Testis
By-
By-
Gaurav Jadhav.
Gaurav Jadhav.
Vaibhav Devkar.
Vaibhav Devkar.


Torsion of Testis
Torsion of Testis
Torsion of testicles is an uncommon
condition which is limited to
peripubertal males.
It causes strangulation of blood supply
to testis and unless treated within 3
to 4 hrs, testicular atrophy is
inevitable.

Predisposing Factors
Predisposing Factors
a) Inversion of testis
b) ong mesorchium!in this case
torsion of testis ta"es place without
torsion of spermatic chord.
c) #ndescended and ectopic testis.
d) $oluminous tunica vaginalis!gives
ade%uate space to testis to rotate.

Pathology
Pathology
&pasm of cremaster muscle is main
initiating factor.
Torsion usually occurs from without
inwards, i.e.
!left testicle rotates!anti cloc"wise
!right testicle rotates! cloc"wise
In torsion along with vascular
occlusion there is oedema of testis
and chord which gradually leads to
gangrene of testis and epididymis.

'istory
'istory
( The patient)s history often indicates
recent hard physical wor", vigorous
exercise, or trauma to the genital
area* however, testicular torsion can
also occur without any apparent
reason

&ymptoms
&ymptoms
( &evere pain in one testicle or in groin
region.
( Pain is sudden and agoni+ing* often
referred to lower abdomen.
( ,ther symptoms may include swelling of
the scrotum, blood in the semen, nausea
and vomiting, and fever.
( - few patients feel the need to urinate
fre%uently.

./amination
./amination
( ,0-
The affected testicle is swollen and
tender.
It usually lies higher in the scrotum
than the unaffected testicle and may
be lying in a hori+ontal position.
The scrotum may be normal or red
and oedematous.

./amination
./amination
,ther e/amination
It is difficult to differentiate testicular
torsion from epididymo!orchitis.
.levation of scrotum relieves pain in
epididymo!orchitis, but increases in
torsion of testis and spermatic chord.

1ifferential 1iagnosis
1ifferential 1iagnosis
Two main 12d are
( -cute epididymo!orchitis! in c2o
torsion of completely descended
testis. .pididymitis is unusual
before age of 34 yrs.
( &trangulated inguinal hernia! in c2o
torsion of incompletely descended
testis.

1iagnosis
1iagnosis
1oppler stethoscope in con4ugation
with ultrasound is simple test to
diagnose this condition.
Testis which is made ischaemic with
torsion will not echo sound* while
hypervascularised epididymis will
increase sound.

Treatment
Treatment
If the pt. comes early!
5anual 1etorsion may be tried.
If detorsion is successful surgical
fi/ation can be done within few days*
if it fails !immediate surgical
e/ploration should be performed.

&urgical procedure
&urgical procedure
( The surgeon ma"es an incision in
the patient)s scrotum and untwists
the spermatic cord.
( The affected testicle is inspected for
signs of necrosis, or tissue death.
( If too much tissue has died due to
loss of blood supply, the surgeon will
remove the entire testicle.

&urgical procedure
&urgical procedure
( If the tissue appears to be healthy,
the surgeon sutures the testicle to
the wall of the scrotum and then
closes the incision.
( In most cases, the surgeon will also
attach the unaffected testicle to the
scrotal wall as a preventive measure.

6ormal anatomy
6ormal anatomy

Torsion of left testicle
Torsion of left testicle

&urgical 0orrection
&urgical 0orrection


Prognosis
Prognosis
If detorsion done within 73 hrs!
good result with 7889 success.
If detorsion is done from 73 to 34
hrs!recovery possible in ma4ority
of cases.

Prognosis
Prognosis
1etorsion can be advised even
from 34 to 3: hrs!but
preservation is doubtful.
If case is delayed by more than
4; hrs!orchidectomy is more
advisable than detorsion
operation.