Torsion of

Testis
By-
Gaurav Jadhav.
Vaibhav Devkar.
 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
a) Inversion of testis
b) Long mesorchium-in this case
torsion of testis takes place without
torsion of spermatic chord.
c) Undescended and ectopic testis.
d) Voluminous tunica vaginalis-gives
adequate space to testis to rotate.
 Pathology
Spasm of cremaster muscle is main
initiating factor.
Torsion usually occurs from without
inwards, i.e.
-left testicle rotates-anti clockwise
-right testicle rotates- clockwise
In torsion along with vascular
occlusion there is oedema of testis
and chord which gradually leads to
gangrene of testis and epididymis.
 History
• The patient's history often indicates
recent hard physical work, vigorous
exercise, or trauma to the genital
area; however, testicular torsion can
also occur without any apparent
reason
 Symptoms
• Severe pain in one testicle or in groin
region.
• Pain is sudden and agonizing; often
referred to lower abdomen.
• Other symptoms may include swelling of
the scrotum, blood in the semen, nausea
and vomiting, and fever.
• A few patients feel the need to urinate
frequently.
 Examination
• LOCAL
The affected testicle is swollen and
tender.
It usually lies higher in the scrotum
than the unaffected testicle and may
be lying in a horizontal position.
The scrotum may be normal or red
and oedematous.
 Examination
Other examination
It is difficult to differentiate testicular
torsion from epididymo-orchitis.
Elevation of scrotum relieves pain in
epididymo-orchitis, but increases in
torsion of testis and spermatic chord.
 Differential Diagnosis
Two main D/d are
• Acute epididymo-orchitis- in c/o
torsion of completely descended
testis. Epididymitis is unusual
before age of 24 yrs.
• Strangulated inguinal hernia- in c/o
torsion of incompletely descended
testis.
 Diagnosis
Doppler stethoscope in conjugation
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
If the pt. comes early-
Manual Detorsion may be tried.
If detorsion is successful surgical
fixation can be done within few days;
if it fails -immediate surgical
exploration should be performed.
 Surgical procedure
• The surgeon makes 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.
 Surgical 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.
Normal anatomy
Torsion of left testicle
Surgical Correction
 Prognosis
If detorsion done within 12 hrs-
good result with 100% success.
If detorsion is done from 12 to 24
hrs-recovery possible in majority
of cases.
 Prognosis
Detorsion can be advised even
from 24 to 36 hrs-but
preservation is doubtful.
If case is delayed by more than
48 hrs-orchidectomy is more
advisable than detorsion
operation.