Page 31 - Urological Health

Tests:

• If you have had testicular torsion before, you don’t need tests to confirm the diagnosis.
• If not, you will likely need a colour flow Doppler ultrasonography. This will see if you have
testicular torsion and also find a cause for your scrotal pain.
• To see if there is any blood flow to the your testicle, you may be given a radionuclide scan.
You either swallow the radionuclide or inject it in your arm. The gamma rays produced by
the radionuclide will assess your blood levels.

• If your doctor suspects you have an infection, you may have to give a urine sample.

Myth watch:
• Prehn’s sign, or relief of pain with scrotal elevation, was historically taught as a way to
differentiate epididymitis (pain relief with scrotal elevation) from testicular torsion.
This “test” is totally unreliable and has not been proven.

Appendage torsion:
• If you have appendage torsion (a small piece of tissue on the outside of the
testicle), this is not a surgical emergency.

• Appendage torsion mostly occurs in children between eight and 11 years old. It is
treated with pain relief medications, possibly nonsteroidal anti-inflammatory
agents, and limiting activity.
• It takes about one to two weeks for the pain to subside.

Treatment:
• Surgery to untwist the testicle and to fasten both testicles in place (or pexing) to prevent
the twisting from happening again. This surgery is called orchidopexy.
• In the ER, manually untwisting the testicle (or manual destorsion) by the ER doctor may
allow your blood to flow again in the testicle (or reperfusion).

• The blood flow to your testicle can be obstructed with a little twist, so it is
important that your doctor explore the outcome surgically before a successful
manual detorsion.
• You may need regular follow-ups to check the testicles after surgery; your primary
doctor or urologist may do the follow-up.

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