TESTICULAR TORSION

Definition
• Torsion of the spermatic cord structures and subsequent loss
of the blood supply to the ipsilateral testicle.
 Pathogenesis
• Sudden temperature changes
• Sudden increased intraabdominal pressure
• Trauma to the scrotum
• In too tight pants
Anatomy
 Phisiology
• Within tubulus seminiferus of testis there are spermatogonia
cells and Sertolli cells.
• Sertolli cells function to feed the future sperm cells.
• Leydig cells : produce testosteron.
 Type

A: Extravaginal torsion
B : Intravaginal torsion
 History

– Severe sudden scrotal pain 

followed by scrotal swelling
– Can be related to trauma in 4-8% of
cases, or can develop
spontaneously
– Pain reffered to inguinal or lower
abdominal region
 Physical examination
• Inspection:
– swollen, tender, high-riding testis
with abnormal transverse lie
• Palpation:
– Negative cremasteric reflex
– Thickening of spermatic cord
– There’s no relief of pain with
elevation of the testicle (Prehn’s
test)
 Laboratory
• Urinalysis results are usually
normal in testicular torsion
• Complete blood count can be
normal
 Adjunct
– Doppler ultrasound blood flow to
the testis 
no blood flow to the testis
 Differential diagnosis
• Acute epididimistis
• Incarserated inguinal hernia
• Infected hydrocele
 Management
• To restore intial • When manual
anatomical position detorsion failed
of the testis • When in doubt 
• Detorsion to lateral treat it like a torsion
side, if failed to until proofed not a
medial side torsion.
Manual Operative
Detorsion management
 INDICATION BAIILEY & LOVE PRACTICE OF SURGERY)

ORCHIDECTOMY ORCHIDOPEXY
• Non viable testis • Viable testis
 Orchiectomy Procedures
• Patient in general anesthesia or spinal block.
• Operator in the left patient.
• Patient in supine position

(Hinman’s Atlas of Urologic Surgery,3rd ed)

• Reading patient’s checklist
• Desinfects the abdomen, penis, and both inner thigh with
Povidone Iodine 10%
• Cover it with sterile drappings.

• (Hinman’s Atlas of Urologic Surgery,3rd ed)

• Make the para raphe incision,
open layer by layer until the
tunica vaginalis
• Identification of spermatic cord to healthy
tissue
– Torsion?
– Direction?
– Degree?
– Intravaginal or extravaginal?
• Check the viability of the testicle.
– VIABLE  orchiopexy
– UNVIABLE  orchiectomy
• Carried out the spermatic cord by
using forceps Kocher clamp 's in 2
places,
• Ligate the spermatic cord silk 2-0
then funiculus cut on the distal
ligation
• Sent the specimen to pathology
• Tunica dartos sutured with
absorbable suture stitch
together using a absorbable 3-0
• Scrotal skin is stitch by
absorbable 3-0
 Orchiopexy

• Orchidopexy : surgical procedure that places the testicle in the

scrotum
(GALE ENCYCLOPEDIA OF MEDICINE)
Orchiopexy
• Fixation three sites on the testis
with non absorbable between
tunica albuginea and tunica
dartos
 Complication
Early Complications

Late complications
- Scrotal hematoma - Retorsion.
- Testicular necrosis.
- Hydrocele.
- Testicular atrophy.
- Infection
 Post ooperative Management
• Scrotal support
• Wound care.
• Analgetics.
• Activity restriction.
Thank you