Description

• Rotation of the testicle around the spermatic cord and vascular pedicle
• Rotation often occurs medially (2/3 of cases):
  • Ranges from incomplete (90–180°) to complete (360–1080°) torsion
  • Depending on the degree of torsion:
    • Vascular occlusion occurs
    • Infarction of the testicle after more than 6 hr of warm ischemia
• Testicular salvage:
  • 73–100% with <6 hr of ischemia
  • 50–70% at 6–12 hr
  • <20% after 12 hr
  • It is still worthwhile to attempt to salvage the testicle up to 24 hr after the onset
• Testicular infarction leads to atrophy and may ultimately decrease fertility

Epidemiology

Bimodal distribution of torsion:

• Peak incidences in infancy and adolescence
• 85% of cases occur between ages 12 and 18 yr, with a mean of 13 yr
• Torsion is rare after age 30 but still possible

Etiology

• Congenital abnormality of the genitalia:
  • High insertion of the tunica vaginalis on the spermatic cord
  • Redundant mesorchium
  • Permits increased mobility and twisting of the testicle on its vascular pedicle
• The anatomic abnormality is bilateral in 12%, so both testicles are susceptible to torsion
• Neonates can develop extravaginal torsion:
  • Tunica vaginalis has not adhered to the gubernaculum
  • Both tunica vaginalis and spermatic cord are more prone to torsion
  • Can occur weeks to months prior to birth and the treatment is different
• Can be seen in the presence of testicular malignancy in adults