Abstract
Testicular torsion is a painful urologic emergency caused by twisting of the spermatic cord causing compromise of the blood supply to the affected testis. The extent of torsion is variable, ranging from 90 to 720 degrees, with complete torsion occurring with twisting of 360 degrees or greater. Although testicular torsion is primarily a disease of neonates and adolescents, it is occasionally seen in 40- to 50-year-olds as well as in patients who suffer testicular trauma. In adolescents and adults, the tunica vaginalis is attached to the posterolateral aspect of the testes effectively tethering the testes in place. In approximately 17% of patients this attachment is higher than normal, allowing the spermatic cord to rotate within the tunica vaginalis. This anatomic variation, known as the bell-clapper deformity, is associated with an increased incidence of intravaginal testicular torsion in this age group. In neonates, because the tunica vaginalis is not yet attached to the gubernaculum, both the spermatic cord and tunica vaginalis twist as a unit. This type of testicular torsion is called extravaginal torsion and can occur prenatally or postnatally.
Keywords
testicular torsion, spermatic cord, cremasteric reflex, Doppler, doagnostic sonography, orchalgia, TWIST scoring test, infertility, infection, epididymitis
ICD-10 CODE N44.00
Keywords
testicular torsion, spermatic cord, cremasteric reflex, Doppler, doagnostic sonography, orchalgia, TWIST scoring test, infertility, infection, epididymitis
ICD-10 CODE N44.00
The Clinical Syndrome
Testicular torsion is a painful urologic emergency caused by twisting of the spermatic cord causing compromise of the blood supply to the affected testis ( Fig. 95.1 ). The extent of torsion is variable, ranging from 90 to 720 degrees, with complete torsion occurring with twisting of 360 degrees or greater. Although testicular torsion is primarily a disease of neonates and adolescents, it is occasionally seen in 40- to 50-year-olds as well as in patients who suffer testicular trauma. In adolescents and adults, the tunica vaginalis is attached to the posterolateral aspect of the testes, effectively tethering the testes in place. In approximately 17% of patients this attachment is higher than normal, allowing the spermatic cord to rotate within the tunica vaginalis ( Fig. 95.2 ). This anatomic variation, known as the bell-clapper deformity, is associated with an increased incidence of intravaginal testicular torsion in this age group ( Fig. 95.3 ). In neonates, because the tunica vaginalis is not yet attached to the gubernaculum, both the spermatic cord and tunica vaginalis twist as a unit. This type of testicular torsion is called extravaginal torsion and can occur pre- or postnatally.
Testicular torsion is a true urologic emergency and must be treated within 6 hours of symptom onset if the testicle is to remain viable. In almost all patients, testicular necrosis occurs after 24 hours of vascular compromise ( Fig. 95.4 ). Testicular torsion is associated with testicular malignancy. Sequelae of testicular torsion include testicular infarction, infection, infertility, pathologic alterations of the retained injured testis, and postsurgical cosmetic deformity.
