Testicular torsion

Testicular torsion is a twist of the spermatic cord leading to cessation of testicular blood flow , ischaemia and infarction if left untreated Occurs most often in the neonatal period and around puberty ( bimodal with two peaks ) More common at puberty ○ peak incidence 13-15 yrs of agebut it can occur in any age group Left > common than right Incidence in men < 25 yrs is 1 in 4000 intravaginal-Most common type Anatomic anomaly- Bell clapper deformity-↑↑ testicular mobility In adolescents and older males B/L in 40 % cases Extravaginal-More often in neonates In utero or around time of birth Both the spermatic cord & tunica vaginalis undergo torsion together - in or just below the inguinal canal

When the testis twists around the spermatic cord venous blood supply is cut off leading to venous congestion and ischaemia of the testicle which becomes swollen, tender and possibly erythematousTesticle twists further compromising arterial blood supply with eventual testicular ischaemia and necrosis

Presentation-Pain, duration , severity Speed of onset- sudden or gradual What was the patient doing when pain started Previous episodes - self limiting pain and swelling Other symptoms○ LUTS○ urethral discharge○ parotid swelling --> mumps orchitis○ back...