TESTICULAR TORSION

Randa Halfian
 Definition
Torsion of the spermatic cord structures and
subsequent loss of the blood supply to the
ipsilateral testicle.

Pedoman Diagnosis
Terapi Urologi Malang
2010
 Pathogenesis
Sudden temperature changes
Sudden increased intraabdominal pressure
Trauma to the scrotum
In too tight pants

Pedoman Diagnosis
Terapi Urologi Malang
2010
Anatomy

Grays Anatomy XI sec 3c

 Phisiology
Within tubulus seminiferus of testis there are
spermatogonia cells and Sertolli cells.
Sertolli cells function to feed the future sperm
cells.
Leydig cells : produce testosteron.
 Type

A: Extravaginal torsion
B : Intravaginal torsion

Favorito LA, Sampaio FJ, Javaroni V, Cardoso LE,

Costa WS: Anatomic Aspects Of Epididymis And Tunica Vaginalis In
Patients With Testicular Torsion. J Urol. 2004; p420-424
 History

Severe sudden scrotal pain

followed by scrotal swelling
Can be related to trauma in
4-8% of cases,or can
develop spontaneously
Pain reffered to inguinal or
lower abdominal region

Pedoman Diagnosis
Terapi Urologi Malang
2010
 Physical examination
Inspection:
swollen, tender, high-riding
testis with abnormal
transverse lie
Palpation:
Negative cremasteric reflex
Thickening of spermatic cord
Theres no relief of pain with
elevation of the testicle
(Prehns test)
Pedoman Diagnosis
Terapi Urologi Malang
2010
 Laboratory
Urinalysis results are
usually normal in testicular
torsion
Complete blood count can
be normal

Pedoman Diagnosis
Terapi Urologi Malang
2010
 Adjunct
Doppler ultrasound blood
flow to the testis
no blood flow to the testis

Pedoman Diagnosis
Terapi Urologi Malang
2010
 Differential diagnosis
Acute epididimistis
Incarserated inguinal
hernia
Infected hydrocele

Pedoman Diagnosis
Terapi Urologi Malang
2010
 Management
To restore intial When manual
anatomical detorsion failed
position of the When in doubt
testis treat it like a
Detorsion to torsion until
lateral side, if proofed not a
failed to medial Operative
torsion.
Manual
side managem
Detorsion
ent
Pedoman Diagnosis
Terapi Urologi Malang
2010
INDICATION BAIILEY & LOVE PRACTICE OF SURGERY)

ORCHIDECTOMY ORCHIDOPEXY

Non viable testis Viable testis

 Orchiectomy
surgical removal of one or both testes
(MOSBYS MEDICAL DICITONARY 8TH ED)
 EQUIPMENT
Sterile drapping
Sterile gauze
Towel clamp

Hand
Sterile gown gloves Povidone
iodine
10% Sponge forceps
 EQUIPMENT Needle
Metzenbaum Holder
Plain catgut 3-0

Polyprolene 3-0 & Silk 2-0

Kocher forceps
Blade no
15 Pinset
 Orchiectomy Procedures
Patient in general anesthesia or spinal block.
Operator in the left patient.
Patient in supine position

(Hinmans Atlas of Urologic Surgery,3rd ed)

 Reading patients checklist
Desinfects the abdomen, penis, and both inner thigh
with Povidone Iodine 10%
Cover it with sterile drappings.

(Hinmans Atlas of Urologic Surgery,3rd ed)

 Make the para raphe
incision, open layer by
layer until the tunica
vaginalis

SOP Urologi RSSA

Malang 2012
 Identification of spermatic cord to
healthy tissue
Torsion?
Direction?
Degree?
Intravaginal or extravaginal?

Check the viability of the testicle.

VIABLE orchiopexy
UNVIABLE orchiectomy
SOP Urologi RSSA
Malang 2012
 Carried out the spermatic
cord by using forceps
Kocher clamp'sin 2
places,
Ligate the spermatic cord
silk 2-0 then funiculus cut
on the distal ligation
Sent the specimen to
pathology

SOP Urologi RSSA

Malang 2012
 Tunica dartos sutured with
absorbable suture stitch
together using a
absorbable 3-0
Scrotal skin is stitch by
absorbable 3-0

SOP Urologi RSSA

Malang 2012
 Orchiopexy

Orchidopexy : surgical procedure that places the

testicle in the scrotum
(GALE ENCYCLOPEDIA OF MEDICINE)
Orchiopexy
Fixation three sites on
the testis with non
absorbable between tunica
albuginea and tunica
dartos

SOP Urologi RSSA

Malang 2012
 Complication

- Scrotal
Complications
- Retorsion.

Late complications
Early
hematoma - Testicular
necrosis.
- Hydrocele.
- Testicular
atrophy.
- Infection
 Post ooperative Management
Scrotal support
Wound care.
Analgetics.
Activity restriction.
Thank you