Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
Katherine Henrquez
UROLOGA
E SCROTO AGUDO
Williamson RC. Torsion of the testis and allied conditions. Br J Surg. Jun 1976;63(6):465-76.
T ORSIN TESTICULAR
H ISTORIA
Criptorquidia
Trauma testicular
Tumor testicular
12% postmortem
a menudo bilateral
Caesar RE, Kaplan GW. Incidence of the bell-clapper deformity in an autopsy series. Urology.
Jul 1994;44(1):114-6.
T ORSIN TESTICULAR
C LASIFICACIN
Intravaginal Extravaginal
Grupo de edad Adolescencia Perinatal
Frecuencia 90% 10%
Patologa Deformidad en badajo Falta de fijacin de tnica
de campana vaginal parietal a pared
escrotal posterolateral
Clnica Dolor sbito severo Asintomtico
Nuseas y vmitos Testculo indoloro firme
T ORSIN TESTICULAR
HISTORIA CLNICA
Tryfonas G, Violaki A, Tsikopoulos G, Avtzoglou P, Zioutis J, Limas C. Late postoperative results in males
treated for testicular torsion during childhood. J Pediatr Surg. Apr 1994;29(4):553-6.
T ORSIN TESTICULAR
E XAMEN F SICO
HALLAZGOS ANORMALES
Elevacin del testculo con acortamiento del cordn
espermtico
Eje testicular horizontal en paciente de pie
Posicin anterior del epiddimo
Ausencia del reflejo cremastrico (presente no excluye
diagnstico)
T ORSIN TESTICULAR
E XAMEN FSICO
Clnico
Imagenolgico
Ultrasonido escrotal con flujo color Doppler (de
eleccin)
Gamagrafa testicular
Si es ultrasonido no es concluyente
Kalfa N, Veyrac C, Lopez M, et al. Multicenter assessment of ultrasound of the spermatic cord in
children with acute scrotum. J Urol. Jan 2007;177(1):297-301; discussion 301.
Schalamon J, Ainoedhofer H, Schleef J, et al. Management of acute scrotum in children--the impact
of Doppler ultrasound. J Pediatr Surg. Aug 2006;41(8):1377-80.
T ORSIN TESTICULAR
U LTRASONIDO ESCROTAL CON DOPPLER
Torsin parcial o
intermitente
24% vascularizacin
aumentada o normal
Kalfa N, Veyrac C, Lopez M, et al. Multicenter assessment of ultrasound of the spermatic cord in
children with acute scrotum. J Urol 2007 Jan;177(1):297-301.
T ORSIN TESTICULAR
G AMAGRAFA T ESTICULAR
Luscombe CJ, Mountford PJ, Coppinger SM, Gadd R. Diagnosing testicular torsion. Isotope
scanning is useful. BMJ. May 25 1996;312(7042):1358-9.
T ORSIN TESTICULAR
I MAGENOLOGA
T ORSIN TESTICULAR
TASA DE SALVAMENTO TESTICULAR
Duracin de Probabilidad de
isquemia testculo salvable
<6h 90-100 %
6 - 12 h 50-70 %
12 - 24 h 10-20 %
TIPOS ETIOLOGA
Gatti JM, Patrick Murphy J. Current management of the acute scrotum. Semin Pediatr
Surg. Feb 2007;16(1):58-63.
T ORSIN DEL APNDICE
TESTICULAR
Diagnstico
Clnico
Ultrasonido escrotal
con Doppler
Tratamiento
Conservador
Reposo fsico
Soporte escrotal
AINEs
T ORSIN TESTICULAR
D ETORSIN MANUAL
Medida temporal
Detorsin en direccin
lateral
Reduce torsin 180 a 360
Resolucin incompleta en
mltiples revoluciones
Frank JD, O'Brien M. Fixation of the testis. BJU Int. Mar 2002;89(4):331-3.
Kuntze JR, Lowe P, Ahlering TE. Testicular torsion after orchiopexy. J Urol. Dec 1985;134(6):1209-10.
Morse TS, Hollabaugh RS. The "window" orchidopexy for prevention of testicular torsion. J Pediatr
Surg. Apr 1977;12(2):237-40.
T ORSIN TESTICULAR
C OMPLICACIONES
Bennett S, Nicholson MS, Little TM. Torsion of the testis: why is the prognosis so poor?. Br Med
J (Clin Res Ed). Mar 28 1987;294(6575):824.
Bird S. Failure to diagnosetesticular torsion. Aust Fam Physician 2003;32:527-8.
T ORSIN TESTICULAR
C OMPLICACIONES
Atrofia testicular
Subfertilidad 36 39%
Dao de isquemia-reperfusin
Scheiber K, Marberger H, Bartsch G. Exocrine and endocrine testicular function in patients with
unilateral testicular disease. J R Soc Med. Aug 1983;76(8):649-51.
Puri P, Barton D, O'Donnell B. Prepubertal testicular torsion: subsequent fertility. J Pediatr Surg.
Dec 1985;20(6):598-601.
Ozkan KU, Kucukaydin M, Muhtaroglu S, Kontas O. Evaluation of contralateral testicular damage
after unilateral testicular torsion by serum inhibin B levels. J Pediatr Surg. Jul 2001;36(7):1050-3.
T ORSIN TESTICULAR
C AUSAS DE PRDIDA TESTICULAR
Matteson JR, Stock JA, Hanna MK, Arnold TV, Nagler HM. Medicolegal aspects of testicular
torsion. Urology 2001;57:783-7.
Jones DJ, Macreadie D, Morgans BT. Testicular torsion in the armed services: twelve year review
of 179 cases. Br J Surg 1986;73:624-6.
E VALUACIN DEL ESCROTO AGUDO