00:01
Next topic is torsion
of the testicle.
00:05
Let me tell you right off the
bat that this is an emergency.
00:09
And let me give you
a patient here.
00:11
Perhaps you a have
male on a motorcycle
and get’s into an accident
and he falls of the bike,
and the way that he lands or
whatnot then causes torsion, okay?
So if there’s torsion now
that’s taking place,
then now what happens
is the fact that –
My goodness gracious,
you’ve lost blood supply
and on top of that, there’s
a lack of drainage.
00:33
And if you don’t get in there
and surgically correct this,
you, the patient,
who’s suffering from this will
lose your testicle, okay?
So now that you’ve understood
the importance of it,
let’s get into the specifics.
00:48
Urologic emergency, requiring
correction within 6 hours.
00:52
That, you have to know.
00:54
If not, then you’re worried about
risking the loss of your testicle.
00:59
It is a congestion type. Why?
Because torsion,
when you twist the spermatic
cord and company,
then you’re going
to block drainage.
01:07
Ischemia, due to twisting
of the spermatic cord,
compressing the vasculature.
01:12
Not only to the testicle,
but then also the vas.
01:16
Neonatal torsion
is most common on
extravaginal process
as a result of the
tunica vaginalis
not being well-fixed
to the scrotum wall.
01:26
Make sure you know about two types
of torsions here with ages.
01:32
Neonatal, most common will
be called extravaginal,
to scrotal wall.
01:37
The torsion involves the entire
testicle, the tunica vaginalis.
01:42
Now,
it is a distinct entity from
testicular torsion in older patients.
01:47
Let’s walk through this patient.
01:48
Two populations for
testicular torsion
in which you would then
call this intravaginal.
01:54
But when you say
vaginal in a male,
do you understand what
we’re referring to?
Okay.
01:59
There’s no –
This is a genotypic male,
XY, in a phenotypic male.
02:04
So what does “vaginal” refer to?
Tunica vaginalis. Are we clear?
Okay. Now,
when you say
intravaginal torsion,
when the testis twist within the
tunica vaginalis, hence intravaginal.
02:19
Neonatal torsion in infants less than 30 days old is called an "extravaginal process"
because it involves twisting of the testicle, the spermatic cord, AND the tunica vaginalis which has not yet attached to the scrotum.
02:31
Thus, neonatal testicular torsion occurs after the testes descends,
but prior to their fixation within the scrotum.
02:38
In children OLDER than 30 days old as well as adolescents and adults,
testicular torsion does NOT involve the tunica vaginalis and is called an
"intravaginal process" even though it occurs in boys.
02:51
How do you manage this patient?
Well, surgery.
02:54
And the reason for this,
because you’re worried about
losing the testicle.
02:59
Ultrasound and Doppler diagnosis
if low probability of disease.
03:03
And definitive treatment
is surgery, temporizing
and there’s also something
called manual detorsion.
03:09
You do everything in your power
to make sure that you
correct this patient
in the emergency room
or operating room.