03.03 Nursing Care and Pathophysiology for Testicular Torsion

Hey guys, so today’s lesson is about testicular torsion. By the end of the lesson, you will have a better understanding of what testicular torsion is, different causes, assessment findings, diagnostics, therapeutic management, and nursing considerations when caring for these patients.
Ok guys so testicular torsion is when the spermatic cord is twisted and leads to loss of blood supply to the following testicle and if untreated, can lead to loss of the affected testicle. Testicular torsion starts by the testicle rotating inside the scrotum. This leads to the twisting of the arteries and veins in the spermatic cord. This then interrupts blood flow to the affected testis which causes strangulation. This results in vascular engorgement, ischemia, and scrotal swelling. So if you want to look at this picture here with me you can see the spermatic cord and testis. So the testis rotates which causes the spermatic cord to become twisted. Since blood flow is impaired, it causes strangulation of the affected testicle.

So just some additional information on testicular torsion. So this is usually unilateral. So it usually presents in just one of the testes. As long as there is early detection and prompt treatment, the prognosis is very good and the patient does not suffer any defect. Without treatment, or if treatment is delayed, this leads to infarction of the testis due to lack of blood supply. As far as prevalence goes, testicular torsion is most common in males ages 12-18, but can happen at any age.

So testicular torsion can be caused by abnormalities inside or outside the membrane that covers the testicle. One cause is by an abnormality of the membrane and position of the testicle. This then allows the testicle to rotate inside the scrotum. Another cause is that membrane being too loosely attached to the scrotal wall - so basically the testicle can move around a little too freely in there. So of course, with that extra room it causes it to twist and the spermatic cord gets rotated. Another cause is due to the sudden contraction of the cremaster muscle due to irritation or physical exertion. You can kind of think of this like snapping a rubber band. If you snap it fast, it will twist up on you.

So the assessment findings in these patients is pretty straightforward. So they will present with excruciating pain in the affected testis or iliac fossa. They can also have tense, tender swelling in the associated scrotum or inguinal canal. The scrotal swelling is also unrelieved by rest or elevation of the scrotum.

Usually the patient’s presenting symptoms give the provider a good idea for diagnosis. But you can also use an ultrasound to distinguish torsion from other things like a strangulated hernia, undescended testes, or epididymitis.

Ok so with therapeutic management, the provider may try to use manual reduction to try to fix the twisted spermatic cord. So even though manual correction is preferred and least invasive, sometimes it just can’t untwist it. If this happens, they’ll have to use surgical options. Either way, we have to get it corrected within 6 hours to prevent them from losing any function. And after 12 hours, the testicle starts to die. So the good thing is that there are a few options. One is an orchiopexy, which is where they actually secure the testis to the scrotum so it physically can’t twist. Another is an orchiectomy, which is when they remove it completely if it’s already too damaged to fix. After surgery, we need to make sure we focus on pain control, make sure they can void, and use ice to help with edema. And, of course, we want to do really good wound care and dressing changes to prevent any infection or contamination.

We will be teaching our patients about the importance of prompt intervention to restore circulation to the testis as soon as possible. We will educate about the surgical options and post-op care if indicated. We will also teach about how to prevent future incidents, so teaching patients to wear scrotal support when exercising is important to support the scrotum.

One of the nursing concepts is an alteration in comfort as the patient has excruciating pain with testicular torsion. There is alteration in perfusion and tissue and skin integrity as well due to the twisting of the spermatic cord, which impairs blood flow to the associated testis.
The key points I want you to remember regarding testicular torsion include its pathophysiology - so the testis rotates, which twists the spermatic cord, which impairs blood flow. Prompt intervention is critical to restore blood flow and save the testis, whether that is with manual reduction or surgical management. Patient education is important so the patient understands that they should seek treatment immediately, we will educate on surgical care as indicated, and education about prevention is important to try to prevent future episodes from occurring.
Alright guys, that’s it for our lesson on testicular torsion. Make sure to check out the resources attached to this lesson. Now go out there and be your best self today, and as always, Happy Nursing!