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Torsion of the Testis
PptxGenJS Presentation
Prof. Zahid Mahmood
Prof. Zahid Mahmood
1
2026-07-12T03:44:28Z
2026-07-12T03:44:28Z
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بِسْمِ اللَّهِ الرَّحْمَٰنِ الرَّحِيمِIn the name of Allah, the Most Gracious, the Most MercifulPK
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Torsion of the TestisA Surgical EmergencyProf. Zahid MahmoodMBBS, FCPS — General & Laparoscopic SurgeonPK
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Did You Know?You have only 6 hours to save the testis.After 6 hours, the testis may die.A teenager's severe scrotal pain is torsion, until you prove otherwise.Missing it can mean losing the testis.Ultrasound must never delay surgery.PK
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Learning OutcomesDefine torsion of the testis.Describe the bell-clapper deformity.Recognise the clinical features early.Plan urgent investigation and management.Understand why fixation is bilateral.PK
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DefinitionTwisting of the spermatic cord.This cuts off the testicular blood supply.It causes ischaemia and severe pain.A true urological surgical emergency.Common in boys and young men.PK
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Surgical AnatomyTestis is suspended by the spermatic cord.Tunica vaginalis normally covers front and sides.High tunica investment allows free rotation.This is the bell-clapper deformity.The deformity is usually bilateral.PK
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Types of TorsionIntravaginal — within the tunica vaginalis.Common in adolescents and young men.Due to bell-clapper deformity.Extravaginal — whole cord and tunica twist.Seen mainly in newborn infants.PK
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Who Is AffectedPeak age is ten to twenty-five years.Most common around puberty.May follow minor trauma or exertion.Often wakes the patient from sleep.Can occur with an undescended testis.PK
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PathophysiologyCord twists and obstructs venous return.Testis becomes congested and swollen.Arterial supply is then cut off.Ischaemia leads to infarction.Damage is irreversible after six hours.PK
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Clinical Features — SymptomsSudden severe pain in the testis.Pain may spread to groin or abdomen.Nausea and vomiting are common.Often starts during sleep or activity.Previous similar episodes may be reported.PK
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Clinical Features — SignsTestis is swollen, tender and firm.High-riding, elevated testis in the scrotum.Testis often lies in a transverse position.Cremasteric reflex is usually absent.Prehn's sign negative — elevation gives no relief.PK
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Differential DiagnosisEpididymo-orchitis — gradual onset, fever.Torsion of a testicular appendage.Strangulated inguinal hernia.Idiopathic scrotal oedema.When in doubt, explore surgically.PK
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InvestigationsDiagnosis is mainly clinical.Colour Doppler shows reduced or absent flow.Ultrasound must not delay surgery.Urinalysis helps exclude infection.Never wait for tests if suspicious.PK
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Management — PrinciplesImmediate surgical exploration of the scrotum.Aim to operate within six hours.Untwist the cord and assess viability.Manual detorsion may be a temporary measure.Keep the patient nil by mouth.PK
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Surgical TreatmentExpose the testis through a scrotal incision.Untwist and wrap in warm swabs.If viable, fix it — orchidopexy.Use non-absorbable sutures at three points.If non-viable, perform orchidectomy.PK
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Fix Both SidesBell-clapper deformity is usually bilateral.The other testis is also at risk.Always fix the opposite testis too.This prevents future torsion.Counsel the family before surgery.PK
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Complications & PrognosisTesticular infarction and loss.Atrophy of a salvaged testis.Possible reduced fertility later.Salvage is high if under six hours.Outcome is poor with delayed surgery.PK
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Take-Home MessageAcute scrotum is torsion until proven otherwise.Time is testis — act within six hours.Diagnosis is clinical; do not delay for scans.Explore, untwist, and fix if viable.Always fix the opposite testis as well.PK
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AssessmentTen Single-Best-Answer QuestionsPK
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MCQ 1A 14-year-old boy wakes with sudden severe left testicular pain and vomiting. The testis is high-riding and tender. What is the most likely diagnosis?A. Epididymo-orchitisB. Torsion of the testisC. Inguinal herniaD. HydroceleE. VaricoceleKey: BPK
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MCQ 2A 16-year-old presents with acute scrotal pain of 3 hours. The cremasteric reflex is absent on the affected side. This finding most supports:A. EpididymitisB. Testicular tumourC. Torsion of the testisD. Idiopathic scrotal oedemaE. Mumps orchitisKey: CPK
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MCQ 3A boy with testicular torsion has a horizontally lying testis. The underlying anatomical abnormality is:A. Patent processus vaginalisB. Bell-clapper deformityC. Undescended testisD. Ectopic testisE. Absent gubernaculumKey: BPK
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MCQ 4A 15-year-old has suspected torsion. Colour Doppler is not immediately available. The correct next step is:A. Wait for ultrasoundB. Start antibiotics and observeC. Immediate surgical explorationD. Admit for repeat examE. Discharge with analgesiaKey: CPK
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MCQ 5During exploration a torted testis is untwisted, wrapped in warm swabs, and regains colour. The correct management is:A. OrchidectomyB. Close and observeC. Orchidopexy of that testis onlyD. Fixation of both testesE. Biopsy the testisKey: DPK
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MCQ 6A newborn is found to have a firm, painless scrotal swelling. This suggests which type of torsion?A. IntravaginalB. ExtravaginalC. Torsion of appendix testisD. Epididymal torsionE. Mesorchial torsionKey: BPK
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MCQ 7A teenager presents 10 hours after the onset of severe testicular pain, and the testis is black at exploration. The appropriate treatment is:A. OrchidopexyB. Manual detorsionC. OrchidectomyD. Warm packs and waitE. Antibiotics onlyKey: CPK
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MCQ 8A 17-year-old with acute scrotal pain has relief when the testis is elevated. This positive Prehn's sign suggests:A. Torsion of the testisB. Epididymo-orchitisC. Testicular ruptureD. Strangulated herniaE. Testicular tumourKey: BPK
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MCQ 9The single most important factor determining testicular salvage in torsion is:A. Age of patientB. Side affectedC. Time to surgeryD. Type of sutureE. Use of antibioticsKey: CPK
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MCQ 10A 13-year-old has torsion confirmed at surgery. Why is the contralateral testis also fixed?A. To prevent infectionB. The deformity is usually bilateralC. To improve fertilityD. To reduce painE. It is not routinely fixedKey: BPK
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Thank You“In surgery, minutes decide a lifetime.When a young man's future is at stake,act early, act decisively, and neverlet a test delay saving what can be saved.”Prof. Zahid MahmoodPK
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7/23/19Click to edit Master text stylesSecond levelThird levelFourth levelFifth level‹#›PK
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