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Week 3: Acute Illness Presentation – Testicular Torsion

By: Travis Ang, Soseh Babayan, & Bernadette Ashley Villena

FNP 594

Professor Larrea

Overview of the Health Issue

Testicular torsion:

Twisting of the testicles around the spermatic cord

Impaired blood supply

Permanent ischemia or damage to the testicular tissue

Urological emergency → timely intervention is essential as ischemia depends on the time frame of the torsion and the extent of twisting

(Laher et al., 2020)

Epidemiology

Can occur at any age, yet most common in:

Newborns

Adolescence → 12-18 years old

Peak → 13-14 years old

Incidence in males under 25 years old

1 in 4000

(Laher et al., 2020)

Risk Factors

Age

Teenage males

Under 25 years old

Family history

Increased risk if relative had prior history

Sports injury or trauma

High-impact sports

Torsion can happen at any instant, even when asleep

(American Academy of Pediatrics, 2023)

Signs and Symptoms

Pain, pain, pain! (unbearable pain in the scrotum with a sudden start)

Scrotum swelling with no particular reason like trauma

Nausea and vomiting

Uneven testicles, one high riding testicle

Fever

Scrotal erythema

(Mayo Foundation for Medical Education and Research, 2022)

d

Anatomy and Physiology

Testes-male sex organs responsible for the creation of sperm and testosterone secretion

Scrotum-sac that holds the epididymis, testes, distal parts of the spermatic cord

A sudden twist of the testes around the spermatic cord due to the testes not being attached well

The testes are being “put in the a choke hold” cutting all blood supply to the testicles causing the spontaneous pain, swelling and the unbalance

(Urology Care Foundation, 2022)

Diagnostic Tests

Power doppler ultrasound- most sensitive at detecting flow in and out of the testicle

Color doppler ultrasound- can show the speed and direction of blood flow with colors

Urinalysis-can detect WBC to determine if cause was from infection

(Advanced Radiology Consultant, 2021)

Treatment Methodologies

Surgery is required to correct testicular torsion

The sooner the testicle is untwisted, the greater the chance it can be saved.

After 6 hours from the start of pain, the chances of needing testicular removal are greatly increased.

In some cases, manual detorsion can be attempted

Surgery is done under general anesthesia, surgeon will make a small incision in the scrotum, untwist the spermatic cord, and stitch one or both testicles inside the scrotum.

Testicular Torsion in newborns and infants

Very rare, but can occur

(Schick & Sternard, 2022)

Differential Diagnosis

Epididmyitis (N45.1)-Erythema, Swelling and pain

Orchitis (N45)-Swelling in one or both testicles, pain, fever

Testis tumor (C62.90)-Pain, discomfort, swelling

Symptomatic hydrocele (N43)-Swollen testicle or testicular discomfort

Scrotal hematoma (S30.22XA)-swelling, pain, and bruising of the scrotum

(Schick & Sternard, 2022)

Needs of the Patient &/or Family

Post-Operative Education:

Pain medicine, rest and ice therapy will relieve pain and swelling after surgery

Rest at home for several days

Wear a scrotal support for a week after surgery

Avoid strenuous activities for 1 to 2 weeks,

Resume sexual activity after 4 to 6 weeks.

Educate boys that they can still live a normal life following testicular torsion surgery. The loss of one testicle won’t keep a man from having a normal sexual relations and is still likely to father children when the time is right.

Don’t miss follow-up appointments with your urologist after surgery.

(Mount Sinai, 2021)

References

Advanced Radiology Consultants. (2021). Color and power doppler ultrasound. Retrieved March 14, 2023, from https://www.adrad.com/ultrasound/color-power-doppler-ultrasound/#:~:text=Color%20Doppler%20converts%20the%20blood,the%20direction%20of%20blood%20flow.

American Academy of Pediatrics. (2023). Testicle pain & testicular torsion. https://www.healthychildren.org/English/health-issues/conditions/genitourinary-tract/Pages/Testicular-Torsion.aspx

Mayo Foundation for Medical Education and Research. (2022, February 24). Testicular torsion. Mayo Clinic. Retrieved March 14, 2023, from https://www.mayoclinic.org/diseases-conditions/testicular-torsion/symptoms-causes/syc-20378270

Mayo Clinic. (2022). Testicular Torsion. Retrieved from https://www.mayoclinic.org/diseases-conditions/testicular-torsion/diagnosis-treatment/drc-20378274#:~:text=Surgery%20is%20required%20to%20correct,usually%20done%20under%20general%20anesthesia.

Mount Sinai. (2022). Testicular Torsion. Retrieved from https://www.mountsinai.org/health-library/surgery/testicular-torsion-repair#:~:text=You%20may%20wear%20a%20scrotal,about%204%20to%206%20weeks.

Laher, A., Ragavan, S., Mehta, P., & Adam, A. (2020). Testicular torsion in the emergency room: A review of detection and management strategies. Open Access Emergency Medicine, 12, 237-246. https://doi.org/10.2147/OAEM.S236767

Schick, A. M., & Sternard, T. B. (2022). Testicular Torsion. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK448199/#:~:text=Other%20differential%20diagnoses%20to%20be,other%20etiology%2C%20and%20scrotal%20hematoma.

Urology Care Foundation. (2022). Testicular Torsion: Symptoms, Diagnosis & Treatment. Retrieved March 14, 2023, from https://www.urologyhealth.org/urologic-conditions/testicular-torsion

Thank you for viewing 🙂

-Travis, Soseh, & Bernadette

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Intro

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Overview

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Epidemiology

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Risk factors

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Signs and symptoms

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Anatomy and Physio

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Diagnostic test

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Treatment and methodologies

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Differential Diagnoses

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Needs of patient/family

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