Torsio Testis

dr. Rachmat Budi Prasetyo, SpU

Epdidemiologi
Merupakan problem emergency. Penyebab terbesar kerusakan testis karena infark testis (90%) Mungkin didapatkan torsio spermatic cord atau appendix testis Sering pada neonatal dan dewasa muda
Lebih sering lagi pada undecensus testis akibat kurangnya fiksasi

Extravaginal: exclusive pada perinatal Intravaginal: 90% pada dewasa muda

Testicular mesorchial attachments

Normal Testis (A) Bell-Clapper Deformity(B) Mesenteric attachment between epididymis and testis (C) Torsion of Spermatic Cord (D) D same as C, with torsion of mesentery

Extravaginal Torsion

Intravaginal Torsion

Diagnosis
History
Onset nyeri mendadak Riwayat nyeri yang sama 50%

Physical
Cremasteric reflex mungkin hilang Prehns sign: elevasi testis nyeri tidak berkurang Posisi testis horisontal

 Diagnosis
Bila pasti : emergency surgery Bila tidak pasti:
Nuclear scan: fasilitas terbatas Ultrasonography: identifikasi blood flow (Doppler USG) Golden Periode : 6 jam

USG Doppler

Normal

Torsio testis

Diagnosis banding
Epididymoorchitis Torsio appendix testis Torsio appendix epididymis

Torsio vs Epididimo-orchitis
Torsio Puber (12-20 th) Akut Nausea Tidak febris Diangkat sakit Lebih tinggimelintang Urinalisis: normal

Epididymoorchitis Puber-tua Gradual Jarang Kadang febris Sakit berkurang Normal Leukosituria

Testicular Appendages
Appendix testis

Appendix epididymis

Torsion of the Appendix Testis

Usually a more gradual onset, pain moderately severe (but may be as severe as testicular torsion)
Localizes to the superior aspect of the testis Testis is not hard Scrotal erythema and a boggy epididymis are more indicative of a torsed appendix

The classic blue dot sign indicates an infarcted appendix Reactive epididymitis is common If dx is in question, surgical exploration

Penatalaksanaan
Explorasi segera
Vital :
Orchidopexy Orchidopexy contralateral

reduksi

Non vital :
Orchidectomy Orchidopexy contralateral

Testicular Torsion

Prognosis
Refer Emergently!
< 6 jam, 90% viabel > 24 jam, 100% atrofi dan kehilangan testis

Coba manual detorsionoutward

open the book

Puntiran bervariasi 360, 720 or 1440 derajat