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Testicular torsion

Terms in this set (21)

Overview
Abnormal twisting of the spermatic cord caused by rotation of a testis or the mesorchium (a fold in the area between the testis and epididymis)
Causes strangulation and eventual infarction of the testis if untreated
90% of cases unilateral
Overview-Pathophysiology
Normally, the tunica vaginalis envelops the testis and attaches to the epididymis and spermatic cord.
Testicular twisting in intravaginal torsion may result from an abnormality of the tunica, in which the testis is abnormally positioned, or from a narrowing of the mesentery support.
In extravaginal torsion, loose attachment of the tunica vaginalis to the scrotal lining causes spermatic cord rotation above the testis. A sudden forceful contraction of the cremaster muscle may precipitate this condition. (See Extravaginal torsion.)
Overview-Causes
Idiopathic
Congenital anomaly
Exercise
Sexual activity
Trauma
Undescended testicle
Overview-Incidence
This disease may occur at any age.
Overview-Complications
Loss of testicle
Infarction of testicle
Infection
Infertility related to loss of testicle
Assessment-History
Previous episodes of intermittent testicular pain that resolved spontaneously
Sudden scrotal pain
Nausea and vomiting
Abdominal pain
Fever
Assessment-Physical Findings
Scrotal swelling
Extreme testicular pain and tenderness
Horizontal lie of the testicle
Scrotal erythema
Ipsilateral diminishing or loss of the cremasteric reflex
Assessment-Diagnostic Test Results
White blood cell count may be elevated.
Assessment-Laboratory
White blood cell count may be elevated.
Assessment-Diagnostic Procedures
Doppler ultrasonography helps distinguish testicular torsion from strangulated hernia, undescended testes, and epididymitis.
Treatment-General
Manual detorsion
Treatment-Diet
Nothing by mouth before surgery
As tolerated after surgery
Treatment-Activity
As tolerated after surgery
Treatment-Medications
Analgesics, such as morphine
Antiemetics, such as prochlorperazine, metoclopramide hydrochloride, and ondansetron
Treatment-Surgery
Immediate surgical repair by orchidopexy (fixation of a viable testis to the scrotum) or orchiectomy (excision of a nonviable testis); as with ovarian torsion in the female, preservation of the organ is preferred
Nursing Considerations-Nursing Diagnoses
Acute pain
Anxiety
Risk for infection
Risk for injury
Situational low self-esteem
Nursing Considerations-Expected Outcomes
report increased comfort and decreased pain
report feelings of decreased anxiety
minimize the risks of infection
avoid or minimize complications
express positive feelings about him self.
Nursing Considerations-Nursing Interventions
Prepare the patient physically and emotionally for surgery.
Promote the patient's comfort before and after surgery.
Allow the patient to verbalize feelings and fears. Provide clear, honest explanations and answer any questions that he has.
Encourage the use of positive coping strategies.
After surgery, administer analgesics as ordered.
Apply an ice bag with a cover to reduce edema.
Provide surgical site care, including dressing changes as ordered; protect the wound from contamination.
Nursing Considerations-Monitoring
Vital signs
Postoperative status, including surgical site, swelling, and erythema
Urinary elimination patterns
Pain level and management
Coping strategies
Signs and symptoms of infection and complications
Self-esteem
Nursing Considerations-Associated Nursing Procedures
Blood pressure assessment
IV bag preparation
IV bolus injection
IV catheter insertion
Oral drug administration
Postoperative care
Preoperative care
Preparing a patient for urologic surgery, OR
Pulse assessment
Respiration assessment
Surgical wound dressing application
Temperature assessment
Venipuncture
Patient Teaching-General
disorder, diagnosis, and treatment, including the fact that testicular atrophy and decreased sperm counts can occur in the salvaged testicle
postoperative care measures, including wound care if appropriate
need for postoperative follow-up in 1 to 2 weeks (if prepubertal, yearly visits until puberty)
signs and symptoms of infection, such as fever, swelling, redness, and drainage from the wound
positive coping strategies.
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