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Testicular torsion by Dr Teo

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Testicular torsion by Dr Teo

  1. 1. Orchitis and epididymo-orchitis By Dr Teo
  2. 2. Aetiology and pathological features∗ Rare,except a/w mumps∗ Blood-borne infection∗ Surgical procedure on the lower urinary tract,e.g. TUR∗ Organism: Neisseria gonorrhoeae, Escherichia coli and Chlamydia. In young man, the commonest is Chlamydia∗ Tuberculosis
  3. 3. Clinical features∗ Preceding Hx of an operation or of dysuria, frequency and heamaturia∗ Acute pain in scrotum,swelling∗ Epididymis:acutely tender and enlarged(although it maybe difficult to differentiate from the equally tender testis)∗ Overlying redness and oedema maybe present
  4. 4. Investigation∗ FBC: leucocytosis∗ Blood culture: helpful to direct antibiotic treatment∗ Urinalysis: pyuria, organism maybe revealed by culture∗ Aspiration of the epididymis∗ USG: increased blood flow
  5. 5. Management∗ Bed rest,scrotal elevation∗ Tetracycline or erthromycin∗ Other antiobiotic refer to culture∗ Partner should also be investigated and treated
  6. 6. Undescended testis
  7. 7. Epidemiology∗ Both testes are undescend in 30% of premature infants∗ Term:3%∗ One year:1%∗ Spontaneous descent after one year is rare
  8. 8. Aetiology∗ Failure of migration along the normal line of descent∗ Ectopic testis:testicle deviates away from the line and lie in front of the penis in the superficial inguinal pouch,in the perineum or in the thigh.(reason unknown)
  9. 9. Risk factor∗ Prematurity∗ Low birth weight∗ Twin gestation∗ Down syndrome(fetus) or other chromosomal abnormality∗ Gestational diabetes mellitus∗ Prenatal alcohol exposure∗ Hormonal abnormalities (fetus)∗ Toxic exposures in the mother∗ Mother younger than 20∗ A family history of undescended testes
  10. 10. Clinical featuresAn empty scrotal sac or hemiscrotum at 1 year indicates: Proximal to the external inguinal ring(undescended) Truly absent Retractile-the cremaster muscle reflexly pulls the organ up towards the inguinal canal Ectopic
  11. 11. Complication∗ Infertility:inevitable in bilateral and common in unilateral undescent,frequent in those who are undescent treated.∗ Torsion∗ Trauma∗ Inguinal hernia∗ Malignant disease
  12. 12. Investigation∗ USG,CT and laparoscopyManagementTarget is to bring the testicle with its blood supply into the scrotum as early as possibleOrchidopexy:should be done beyong pubertyTesticular prosthesis can be placed in the scrotum
  13. 13. Testicular torsion 1 Epididymis 2 Head of epididymis 3 Lobules of epididymis 4 Body of epididymis 5 Tail of epididymis 6 Duct of epididymis 7 Deferent duct (ductus deferens or vas deferens)
  14. 14. Testicular torsion∗ Testicular torsion occurs when the spermatic cord(from which the testicle is suspended) twists, cutting off the testicles blood supply(ischemia)∗ Cause: recognised complication of testicular maldescent wherein the testis is inadequately affixed to the scrotum allowing it to move freely on its axis and susceptible to induced twisting of the cord and its vessels.∗ Occurs most probably between birth and early adolescence
  15. 15. Twist VS Untwist∗ Twist deprives the organ of its blood supply∗ If untwist does not take place within 6 hours,ischaemia is irreversible,gangrene develops and the testis either suppurates or atrophies
  16. 16. Presentation & Finding∗ Acute severe testicular pain(affected side)∗ Testis is tender,swollen and hang higher up(compared to other side)∗ Poorly localized central abdo pain∗ Vomitting(sometimes)∗ Scrotal skin become red,hot and edematous in later stage∗ Palpation may feel the twisted cordPain is increase or no improvement by raising the testis
  17. 17. Investigation∗ Urinalysis:sterile,acellular urine∗ USG:absence of blood supply to the affected testicle
  18. 18. Management∗ Surgical emergency∗ Non-operative ∗ Maybe possible to de-rotate the testis∗ Surgical ∗ Failure of non-operative reduction require emergency operation ∗ The testis is de-rotated and fixed ∗ The gangrenous testis is removed