ALPHA
Twisting of the spermatic cord with rotation around the testicle. Urological emergency
Typical patient is teenage boy - but can occur at any age
Presentation
- Often triggered by activity - sport. Ask what patient was doing at time of pain
- Acute rapid onset unilateral testicular pain
- With abdo pain and vomiting
- Sometimes abdo pain is the only symptom
- Firm swollen testicle in abnormal position (elevated, horizontal, rotated)
- Absent cremasteric reflex
Management
A scrotal USS can confirm the diagnosis and can show the whirlpool sign - spiral appearance to the spermatic cord and blood vessels. Any delay in treatment is not recommended however.
- Nil by mouth in preparation for surgery
- Analgesia
- Senior urology assessment
- Surgical exploration of scrotum
- Orchiopexy or orchidectomy