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Introduction to the clinical stations
Published in Sukhpreet Singh Dubb, Core Surgical Training Interviews, 2020
Testicular torsion represents a urological emergency resulting from the twisting of the testicle upon its spermatic cord, compromising the vascular supply with a resultant tissue ischaemia. You should always have a high index of suspicion in such patients and a low threshold for escalation.
Surgical conditions
Published in Rachel U Sidwell, Mike A Thomson, Concise Paediatrics, 2020
Rachel U Sidwell, Mike A Thomson
The symptoms mimic testicular torsion but: More gradual onset of testicular painNausea and vomiting uncommonUsually associated with dysuria, pyuria and dischargeOften febrile
Answers
Published in Andrew Schofield, Paul Schofield, The Complete SAQ Study Guide, 2019
Andrew Schofield, Paul Schofield
Acute testicular pain due to testicular torsion is a urological emergency requiring urgent surgery to preserve viable testes. It arises due to anatomical variants in the testicle with a large mesorchium which allow testicular rotation in the tunica vaginalis. Initial venous congestion evolves into arterial compression with rapid onset of testicular ischaemia and necrosis. Delays in scrotal exploration and untwisting lead to testicular death with associated atrophy. Subfertility is a serious complication of testicular torsion. Testicular torsion in young boys may be mistaken for an acute abdomen due to presence of nausea, vomiting and abdominal pain. Emergency scrotal exploration may reveal non-viable testes. In all cases, it is important to fix the contralateral testis to ensure it does not happen on that side in the future. Other causes of testicular pain include epididymo-orchitis, torsion of testicular appendages or acute inguinal lymphadenopathy.
Effect of Chrysin on Endoplasmic Reticulum Stress in a Rat Model of Testicular Torsion
Published in Journal of Investigative Surgery, 2022
Ilke Onur Kazaz, Selim Demir, Gokcen Kerimoglu, Fatih Colak, Nihal Turkmen Alemdar, Ahmet Ugur Akman, Ozan Can Cekuc, Ahmet Mentese
Testicular torsion (TT) is one of the urological conditions requiring urgent intervention and the incidence of TT under the age of 25 is 1 in 4000 [1, 2]. The severity of TT depends on the degree and duration of rotation, as rotation of the spermatic cord reduces/inhibits blood flow to the testicular tissue [2, 3]. Detorsion is the only treatment option of TT [4]. If detorsion is performed 6 h after the onset of TT, the testicular salvage rate is 90%. However, it is stated that this recovery rate drops to 50% after 12 h and below 10% after 24 h [3]. It is estimated that approximately 25% of men with a history of TT experience adult-onset infertility [1, 2]. Although detorsion is the only option for the treatment of TT, reperfusion process causes more severe tissue damage than ischemic condition. This paradoxical situation is called as ischemia/reperfusion (I/R) injury and known to be the main mechanism underlying the etiopathogenesis of TT [3, 4]. As a result of I/R damage, some events occur, such as mitochondrial dysfunction and increase in reactive oxygen species (ROS). The imparied homeostasis over time causes functional cells to die through necrosis and/or apoptosis [5]. Although various in vivo experiments have reported that testicular injury induced by I/R may be reduced by antioxidant substances, there is still no clinical drug available [3].
Evidence-based medicine, the number ‘three’ and its multiples in urological clinical rules
Published in Scandinavian Journal of Urology, 2021
Georges Mjaess, Fouad Aoun, Simone Albisinni, Michel Vanhaeverbeek, Thierry Roumeguère
Warm kidney ischemia is known to be ‘30 min’ among urologists during partial nephrectomy and is based on a canine study in 1975. However, while Funahashi et al. [3] have shown that warm ischemia time in order to preserve kidney function is ideally <20 min, Parekh et al. [4] have concluded that a human kidney can tolerate 30–60 min of controlled clamp ischemia, and the ancient concept that ‘every minute counts’ is revoked. Moreover, the typical window of opportunity for surgical intervention in testicular torsion is thought to be ‘6 h’ from onset of pain with a proved 90% salvage rate. However, a recent systematic review has demonstrated that survival of testis (1) can be much longer than 6 h ‘that is commonly taught’, and (2) is believed to be significant even after 24 h of testicular torsion [5].
Is follow-up ultrasound necessary after acute epididymitis? A retrospective analysis from a large university hospital
Published in Scandinavian Journal of Urology, 2018
J. Capet, J. Sønsksen, R. Bisbjerg, M. Fode
Our results show that, in the majority of cases, patients were correctly diagnosed with simple epididymitis in the acute setting or had insignificant and incidental findings such as hydrocele, spermatocele, and varicocele on follow-up US. However, one patient had neglected testicular torsion and one had testicular tuberculosis, while four patients were diagnosed with testicular cancer. Regarding the case of testicular torsion, this is mainly considered a clinical diagnosis and it should have been caught due to pain in the acute setting. In this case, the follow-up US would obviously not help salvage the testicle. Similarly, testicular tuberculosis is a rare event in northern Europe [5,6] and it can hardly be justified to let a single case in our series influence future clinical management. Even without the appointment, the patient is likely to have returned to his doctor due to persisting symptoms after the initial emergency department visit.