CC July 2017 Testicular torsion

echoecho's version from 2017-11-02 00:01


Question Answer
Define testicular torsion?a twisting of the testicle and spermatic cord, occurring at any age but peaking in the first year of life and again at age 13-15
This occurs in ____ individuals per 100,000/year in individuals under the age of 18 years?3.8
Do genetics paly a part in the etiology of this condition?uncertain whether it does or not
In the older patient, what has been implicated as a potential precipitating factor, but torsion can also occur spontaneously?intense exercise such as biking
In the neonatal period, which is more common (extravaginal torsion or intravaginal torsion)?extravaginal torsion (involving the cord, testicle and processus vaginalis)
Define extravaginal torsion?due to lack of fixation of the tunica vaginalis to the scrotum
Prenatal torsion may be present as what at birth?as unilateral absence of a testicle or with scrotal swelling at birth, and teh small, residual testis is almost always nonfunctioning
What is postnatal torsion? it is a tender erythematous scrotum and is treated as a surgical emergency in an effot to preserve a viable testis
There is some controversy about when to explore _____ torsion?perinatal torsion
Essential to making the dx of postnatal torsion is the fact that the scrotum and its contents were _____ at birth?normal
What is the presentation of testicular torsion in the pubescent and adult male?acute, unilateral scrotal pain, abdominal pain, nausea, vomiting, swelling and erythema of the scrotum may become apparent shortly after onset
True or false?Torsion may be intermittent, with pain-free periods between acute periods?true
In the above classic scenario, what should be undertaken as soon as possible to prevent loss of the testicle?surgical exploration
Physical exam findings of testicular torsion?the affected testicle may be high-riding, with loss of its perpendicular orientation. The cremasteric reflex is almost always ABSENT on the affected side
List the few conditions that mimic testicular torsion with its acute onset and systemic symptoms?1) acute epididymitis 2) trauma 3) surgery 4) testicular neoplasm 4) hernia 5) mumps orchitis 6) referred pain
*** The hx and PE are most helpful int he differential dx. If needed what imaging study is highly sensitive and specific for torsion but should NOT be ordered if a significant delay in surgical intervention is likely to occur?color Doppler US
List one condition where Doppler US is helpful in the dx of what?torsion of appendix testis / epididymis (which can mimic testicular torsion), but does not require immediate surgery
Immediate surgical repair is imperative, why?because in as few as 4-6 hours, there may be significant ischemia, resulting in loss of function of the affected testicle
What does the procedure include?1) detorsion 2) fixation
Why is exploration of the contralateral side at the time of surgery indicated?because lack of testicular gubernaculum fixation to the tunica vaginalis is often bilateral
At the time of surgery, what is performed if the testicle is nonviable and the availability of a ____ should be discussed?orchiectomy; prosthesis
Failure to remove a nonviable testicle results in infertility, why?because of the breakdown of the blood-testis barrier, even if the contralateral testicle is normal at the time of exploration
*** SUMMARY = Testicular torsion is a surgical emergency and must be suspected in patients with what pain?acute testicular pain
*** SUMMARY = US with Doppler flow study is highly sensitive and specific but should not _____ surgery?delay
*** SUMMARY = If the testicle is not viable, what procedure is performed to prevent future infertility?orchiectomy