First off, what is testicular torsion? Well, it’s the twisting of the testicle on the spermatic cord, ultimately leading to ischemia and necrosis.
The most common type of torsion is intravaginal torsion from a bell clapper anatomic deformity or trauma. This is a medical emergency.
Signs and Symptoms for Testicular Torsion
The patient will present with acute onset of testicular pain.
The patient may also have swelling, erythema, and nausea/vomiting. The patient will have an absent cremasteric reflex on the side of torsion, along with a high riding testicle.
Negative Prehn sign will be seen. Prehn sign is positive, when there is pain relief after lifting the testicle.
A positive Prehn sign is seen with epididymitis.
If diagnosed clinically, then patients should be sent for immediate surgical exploration without ultrasound.
For those in which the diagnosis is uncertain, a doppler ultrasound should be ordered; which will show decreased perfusion to the affected testicle.
Treatment for Torsion
This should be treated surgically, as soon as possible. If the patient cannot be scheduled for immediate surgery, manual detorsion should be attempted.
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