Emergency Duty Report

UROLOGY TEAM C
NAME AGE / SEX DIAGNOSIS MANAGEMENT OUTCOME
A. N. 54, F Haematuria 2” Invasive Haemotransfusion, bladder
high grade urothelial irrigation,
carcinoma, complicated
by anemia

T. H. 82, M UROSEPSIS FBC, RFT, Urine RE & CS DAMA

BPH with suprapubic Emperic Antibitoitc therapy
catheter
Closed left
pretrochanteric fracture.
NAME AGE / SEX DIAGNOSIS MANAGEMENT OUTCOME
78/ M Prostate CA with spine mets, Urine RE, Culture Mental state
Urosepsis Emperic antibiotic therapy improved.
Palliative care team Stable at CDU Male.
consult

A,A,M 23/M Left Ureteric Calculus (0.3 x Low dose CT, urine RE, CS Improved pain
0.2)cm Analgesics,
Associated mild left IV fluid hydration
hydronephroureter antibiotics
NAME AGE / SEX DIAGNOSIS MANAGEMENT OUTCOME

EKM 59/M Retention of Urine

2” suspected urethral
stricture

69,M Known DM and HPT Urethral Clear urine draining.

With LUTO secondary to catheterization with Review with
suspected BPH introducer PSA,urological USG,
RFT.
NAME AGE / SEX DIAGNOSIS MANAGEMENT OUTCOME
BM 18/M Right Testicular Analgesics, Satisfactory
Tortion Hydration
Counselling
Right Orchidectomy
Left Orchidopexy
NAME AGE / SEX DIAGNOSIS MANAGEMENT OUTCOME
NAME AGE / SEX DIAGNOSIS MANAGEMENT OUTCOME
CASE OF INTEREST
Name : K.E.
Age : 17yrs
Sex: Male
Religion: Christian
PC: Painful right hemi-scrotum – 5/7
HPC: in usual state of health, sudden onset of pain in the right hemi-
scrotum. The pain was constant, increased in severity rapidly (8/10)
radiating to the general abdomen, associated with non-bloody non
bilious vomiting. The pain was relieved only by administration of iv
analgesics when he reported to a peripheral facility.
He was admitted there and managed as a case of peptic ulcer disease.
He was discharged after 1 day. The pain however did not subside
completely, but recurred after 2 days. This time associated right scrotal
swelling. He went to a different peripheral hospital, and upon
assessment, did a scrotal Doppler usg which showed right testicular
torsion with no blood flow to the right testes. Referred thereafter.
• Odq: No fever, No urethral discharge, no haematuria, no dysuria, no
prev hx of scrotal pain.
• Drughx: no medications or herbal conconction was taken, no drug
allergies, IV analgesics from peripheral.
• Pmhx: nil of note
• Fhx: nil of note
• Shx: SHS student Kumasi Anglican 3rd yr , alcohol-, smoking-, he
reports not sexually active.
• O/E=YOUNG MALE, who appears to be in pain and discomfort. NOT IN
RESPIRATORY DISTRESS,J-,P-,WELL HYDRATED
• CVS=S1+S2 MO
• BP-138/88MMHG,HR-112BPM
• R/S= RR 19cpm A/E IS ADEQUATE SYMMETRICAL, BS,
NO ADDED,SPO2-98% ON RA
• ABD=FULL,SOFT,NON-TENDER
• CNS=GCS-15/15
Status Localis
• Swollen right hemiscrotum,
• Tender
• High riding testes, hard, not transilluminable
• Negative Prehn’s sign.
• Absent cremasteric reflex.
Diagnosis: Right Testicular Tortion
PLAN
IV analgesia and antibiotics
Resuscitation and maintenance IVF
Prep for scrotal exploration whiles samples for FBC, RFT, GXM.
Patient and Parents counselling on Risks and possible outcomes of
surgery. Informed Consent.
To keep NPO
• Under Conscious sedation, Bilateral spermatic cord block, Median raphae
local block, the skin was shaved and prepped under WHO aseptic protocol.
• Median Raphae incision was made and the the right hemiscrotum entered
via dissection.
• The testis and epidydimis were identified and inspected. Bell clapper
deformity seen with a 360* intravaginal rotation of the right testis.
• The testes and epidydimis were ischemic and odematous, persisting after
de-torsion and warming
• Right Orchidectomy performed. Haemostasissecured and hemiscrotum
closed.
The Left hemiscrotum was also explored with findings of healthy
normal testes.
Orchidopexy of Left testes performed.

Post op condition was satisfactory

Currently on Admission on B2, analgesics, hydration antibiotics.
PLAN
Continue iv antibiotics and analgesia
Further counselling of patient and relatives
On care and danger signs for remaining left testes.
Literature Review on fertility post TT
• Bimordal age distribution
• Time from onset to detorsion
• Orchidopexy vs orchiectomy
• (Zhang X et al, 2020) investigated the effect of early-life unilateral testicular
torsion on adult male fertility.
• Seventy-two patients with testicular torsion; 49 had undergone orchiectomy,
while 23 had undergone surgical repositioning/orchiopexy.
Pregnancy rate Median time to pregnancy
Orchiectomy 83.67% (41/49) 1.6 years
orchidppexy 91.30% (21/23) 0.75 years

• The recent pregnancy rate was higher in patients with torsion in childhood
than in patients with torsion in adolescence; it was lowest in patients with
torsion in adulthood.
• Conclusion
• Onset of unilateral testicular torsion early in life has a negligible effect on
adult male fertility.
• Jacobsen FM et al, 2020 The Impact of Testicular Torsion on Testicular
Function
• Impairment of exocrine testicular function has been described in
various studies, which also report altered sperm morphology and
decreased sperm motility and sperm count.
• Although the clinical effect of impaired semen quality has not been
specifically addressed in these studies, pregnancy rates were similar
in comparisons of men after TT and the average male population.
• A systematic review compiled 2,116 cases from 30 papers and
investigated the correlation between testis survivability and the
duration of torsion. When operated within 0 to 6 hours of torsion
97.2% of testes survived and after 25 to 48 hours of torsion only
24.4% of testes survived.
• Testicular survival after prolonged torsion might reflect that the
testicular blood flow was not fully constricted, or that intermittent
torsion occurred, highlighting the importance of the degree of
torsion.
THE IMPACT OF TESTICULAR TORSION
ON THE CONTRALATERAL TESTIS
• 1) Ipsilateral reperfusion injury causes contralateral reflectory
sympathetic mediated vasoconstriction leading to hypoxia.
• 2) The torsion of the ipsilateral spermatic cord breaks down the
blood-testis barrier. This initiates an immunological process where
immunoglobulins have antibody activity against sperm antigens
These immunoglobulins, also called anti-sperm antibodies (ASA), will
in turn reduce sperm motility and sperm concentration.
• 3) The contralateral testicular function is compromised before TT due
to pre-existing congenital testicular dysgenesis
• 1.Zhang X, Zhang J, Cai Z, Wang X, Lu W, Li H. Effect of unilateral testicular torsion at different ages on male
fertility. Journal of International Medical Research. 2020;48(4). doi:10.1177/0300060520918792
• Törzsök, P.; Steiner, C.; Pallauf, M.; Abenhardt, M.; Milinovic, L.; Plank, B.; Rückl, A.; Sieberer, M.; Lusuardi,
L.; Deininger, S. Long-Term Follow-Up after Testicular Torsion: Prospective Evaluation of Endocrine and
Exocrine Testicular Function, Fertility, Oxidative Stress and Erectile Function. J. Clin. Med. 2022, 11, 6507.
https://doi.org/10.3390/jcm11216507
• Jacobsen FM, Rudlang TM, Fode M, Østergren PB, Sønksen J, Ohl DA, Jensen CFS; CopMich Collaborative.
The Impact of Testicular Torsion on Testicular Function. World J Mens Health. 2020 Jul;38(3):298-307. doi:
10.5534/wjmh.190037. Epub 2019 Apr 10. PMID: 31081295; PMCID: PMC7308234.
• Karagüzel G, Güngör F, Karagüzel G, Yildiz A, Melikoğlu M. Unilateral spermatic cord torsion without
ipsilateral spermatogenetic material: effects on testicular blood flow and fertility potential. Urol Res.
2004;32:51–54.
• Arora P, Sudhan MD, Sharma RK. Incidence of anti-sperm antibodies in infertile male population. Med J
Armed Forces India. 1999;55:206–208
• Anderson JB, Williamson RC. The fate of the human testes following unilateral torsion of the spermatic
cord. Br J Urol. 1986;58:698–704.