Testicular Torsion
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Basics
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 degrees) to complete (360–1,080 degrees) 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 12–18 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
-- To view the remaining sections of this topic, please log in or purchase a subscription --
Basics
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 degrees) to complete (360–1,080 degrees) 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 12–18 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
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