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- Rotation of the testicle around the spermatic cord and vascular pedicle
- Rotation often occurs medially (two-thirds of cases):
- Ranges from incomplete (90–180°) to complete (360–1,080°) 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.
EpidemiologyBimodal 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.
- 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.