Overview

• Testicular Torsion → twisting of spermatic cord causing testicular ischaemia and necrosis. Only viable for 6 hours.
• Undescended Testes (Cryptorchidism) ⇒
  • Occurs in 2-3% of male infants, more common if baby is preterm.
  • Complications → infertility, torsion, testicular cancer, psychological.
  • Management (if present at birth) →
    • Unilateral → review at 6-8 weeks. 6-8 weeks: if unresolved, re-examine at 3/4/5 months. 4-5 months: if unresolved, refer to paediatric surgeon by 6 months.
      • Surgery → orchidopexy.
    • Bilateral → review by senior paediatrician/endocrinologists within 24 hours. Genetic or endocrine testing may be necessary.
• Torsion of Appendix Testes ⇒
  • Hydatid or Morgagni – a Mullerian remnant.
  • More common, but pain evolves over multiple days.
  • Surgery often needed as cannot be distinguished from true torsion. STILL REQUIRES IMMEDIATE EXPLORATORY SURGERY.
  • If a ‘blue dot’ is seen over the superior pole of the testes, no surgery may be needed, only simple analgesia.

Making Diagnosis

Clinical Features

• Severe + sudden-onset pain.
• N&V.
• Swollen, tender testis retracted upwards.
• Loss of Cremasteric reflex.
• Negative Prehn’s sign (elevation of testes does not ease pain).
  • If elevation of testes eases pain → epididymo-orchitis.

Investigations

Management Plan

• Admit Immediately → IV fluids, NBM, antiemetics, analgesia.
• Immediated surgical exploration + bilateral orchidopexy.