Dr Jo Schoeman
Urological Surgeon

        

Scrotal Exploration for Testicular Torsion

Product Summary: AMA rates

Surgical salvage of a twisted spermatic cord, with orchiopexy and spermatic cord block

Item Number: 37604, 18262, 105

Who is susceptible?

  • Newborn babies: Often missed diagnosis.
  • 12-16 year old boys as their testes increase in size with puberty.

Why is it done?

  • To reverse a twisted spermatic cord compromising blood supply to the testis.
  • This should be done within 4-6 hours of the first presenting symptoms.
  • A failed manual de-torting of the testis.

Pre-requirements

  • An informed consent is required from the patient.
  • This is an EMERGENCY.
  • Patients should preferably not have had any food or drink 6 hours prior. Otherwise the risks of an Urgent intubation should be discussed by the anaethiatist.
  • Patients are to refrain from smoking before the procedure.
  • Patients allergic to IODINE/CHLORHEXIDINE should clearly state this to theatre staff and Dr Schoeman.
  • The whole scrotum will be shaved prior to the procedure.

How is it done?

  • This procedure is performed under general anaesthetic.
  • A single incision is made on the midline raphe of the scrotum.
  • The affected testis and vas deference is then extracted through this incision.
  • The testis is then un-twisted.
  • The testis is then covered with a warm wet swab, encouraging blood supply in the testis by means of vaso-dilatation.
  • Once the dusky blue-grey colour is replaced by a pink colour, the testis is pexed to the dartos muscle.
  • If the testis is black on opening the scrotumand no change occurs with the revival process, the testis is removed.
  • A dressing is then applied, which should be removed after 72 hours.
  • No strenuous movements are permitted for at least 14 days.

What to expect after the procedure?

  • Any anaesthetic has its risks and the anaesthetist will explain all such risks.
  • A haematoma (blood collection under the skin) may form and needs to be reviewed by Dr Schoeman as soon as possible. Bruising is normal.
  • An infection of the wound can occur and requires immediate attention.
  • Owing to the nature of the surgery and the soft skin of the scrotum, bruising may appear to be much worse than it actually is and is no cause for alarm.
  • DANGER SIGNS: A scrotum that swells immediately to size of a football, fever, puss. Contact Dr Schoeman or the hospital immediately as this may occur in up to 5% of all cases.

What next?

  • The dressing should be kept dry for the initial 72 hours after surgery and then soaked in a bath until the dressing comes off with ease.
  • The dressing may sometimes adhere to the wound causing slight bleeding on removal. Don’t panic, the bleeding will stop.
  • Do not tug at the sutures!
  • On discharge a prescription may be issued for patients to collect.
  • Please direct all further queries to Dr Schoeman’s rooms.
  • PLEASE CONTACT THE HOSPITAL DIRECT WITH ANY POST OPERATIVE CONCERNS AND RETURN TO THE HOSPITAL IMMEDIATELY SHOULD THERE BE ANY SIGNS OF SEPSIS.

Scrotal Exploration For Testicular Torsion Scrotal Exploration For Testicular Torsion (243 KB)