TESTICULAR TORSION

Presenter:
R Satria Surya Candra
Inthan Atika

Supervisor :
dr. H. Marta Hendry, Sp.U, MARS

FACULTY OF MEDICINE SRIWIJAYA UNIVERSITY

DEPARTMENT OF SURGERY
DR. MOH. HOESIN GENERAL HOSPITAL PALEMBANG
 OUTLINE
Introduction
Anatomy
Epidemiology
Etiology & patophysology
Diagnose of testicular torsion
Differential diagnose
Treatment
Complication
Prognosis
Conclusion
 INTRODUCTION
PENDAHULUAN
the disease process whereby
there is cessation of blood
Testicular
Torsion ? flow to the testicle because
of an occlusion of arterial
blood supply due to twisting
of the artery (and associated
structures)
 INTRODUCTION

Congestion

Urological
Urological
Emergency
Emergency

Nausea Testicular Edema

and Torsion
Vomitting Skrotum

Acute
Pain
 ANATOMY
Organ
Masculina
Interna
 ANATOMY
Anatomy Of Testis
 ANATOMY
Anatomy Of Testis
 ANATOMY
Vascularization
TINJAUAN PUSTAKA
DEFINITION

Testicular torsion is
described as the twisting
of the spermatic cord,
resulting in acute pain
and ischaemia
 ETIOLOGY AND PATOPHYSIOLOGY

Extravagina
In this type of torsion, there is lack
of fixation of the gubernaculum
and testicular tunica to the scrotal
wall, which allows for the entire
testis, spermatic cord, and tunica
vaginalis to twist
 ETIOLOGY AND PATOPHYSIOLOGY

Intravagina

The spermatic cord twists inside the

tunica vaginalis. This is thought to
occur because of an abnormal
attachment of the spermatic cord to
the testis, which allows the testis to
turn easily within the scrotum.
Bell Clapper Anomali
 Diagnosis
DIOGNOSE OF TESTICULAR TORSION
Symptom
It may be localized not only in the scrotum

Acute Pain but also into the groin and lower abdomen,
imitating an acute abdominal event

Edema Elevation and the location of the scrotum

more horizontally than contralateral testis

scrotum

Nausea and Sometimes.

vomitting
 DIOGNOSE OF TESTICULAR TORSION
Physical Examination
Inspection
Asymmetric positioning of the testicles with the torsed testicle occupying A high
position in the scrotum, which is termed A high-riding testicle.

Absence of a cremasteric reflex is associated with torsion

 DIOGNOSE OF TESTICULAR TORSION
Physical Examination
Palpation
The normaltesticle mustbe palpated first. It should be in a vertical position.

painful palpation and scrotal edema

Clinical examination of the abdomen is normal

 DIOGNOSE OF TESTICULAR TORSION
Additional Examination
Laboratory test

Doppler ultrasonography

Surgical Exploration
 DIFFERENTIAL DIOGNOSE
Diagosis Clinical clues
Acute epididymitis Acute scrotal pain is usually accompanied by a rise in body
temperature
Discharge of pus from the urethra
Had undergone previous urethral catheterization
If done testicular elevation, pain in acute epididymitis sometimes be
reduced
Inguinal hernia or Fluctuation of swelling or mass throughout day or with activity
hydrocele Groin mass

Trauma Ecchymosis
History of trauma or mechanism of injury
Tumor Elevated tumor markers or abnormal
laboratory test results
Hard mass within testicle
Systemic symptoms (if metastatic)

Varicocele Dull, aching pain

Fluctuation of swelling or pain throughout day or with activity
 TREATMENT
NON OPERATIVE
MANUAL DETORSION

The testes are typically detorsed from the medial to

lateral side, turning the physician's hands as if
opening a book.

Return of blood flow to the testicle on Doppler

ultrasonography serves as an objective end point and
should always be documented;
 TREATMENT
OPERATIVE
ORCHIECTOMY
Performed if the affected testicle appears grossly
necrotic or nonviable
Age and prolonged time to definitive treatment have
been identified as risk factors for orchiectomy.
ORCHIOPEXY
If the affected testicle is deemed viable

with permanent suture should be performed to

permanently fix the testicle within the scrotum.
 COMPLICATION

Testicular Atrophy
testicular infarction
Infection
Infertility secondary to the loss of the
testicles
 PROGNOSIS

It has been suggested that if the torsion

is successfully repaired within 6 hours of
symptom onset, there is an 80100%
salvage rate, whereas the salvage rate
drops to 20% after 12 hours
 CONCLUSION

Testicular torsion is described as the twisting of the

spermatic cord, resulting in acute pain and ischaemia

Testicular torsion is an Urological Emergency

Determine Prognosed
 CONCLUSION

Extravaginal torsion may occur antenatally or in the early

postnatal period and typically presents as painless scrotal
swelling, with or without acute inflammation

In older children and adults, testicular torsion is usually

intravaginal (twisting of the cord within the tunica vaginalis)

Prompt restoration of blood flow to the ischemic testicle is critical

in cases of testicular torsion,and prompt referral to a urologist is
recommended
Thank you
TERIMA KASIH