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Testicular Torsion

Testicular Torsion is a topic covered in the 5-Minute Emergency Consult.

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Basics

Description

  • 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.

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.

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Citation

Rosen, Peter, et al., editors. "Testicular Torsion." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307321/all/Testicular_Torsion.
Testicular Torsion. In: Rosen P, Shayne P, Barkin AZ, et al, eds. 5-Minute Emergency Consult. 5th ed. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307321/all/Testicular_Torsion. Accessed April 25, 2019.
Testicular Torsion. (2016). In Rosen, P., Shayne, P., Barkin, A. Z., Wolfe, R. E., Hayden, S. R., Barkin, R. M., & Schaider, J. J. (Eds.), 5-Minute Emergency Consult. Available from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307321/all/Testicular_Torsion
Testicular Torsion [Internet]. In: Rosen P, Shayne P, Barkin AZ, Wolfe RE, Hayden SR, Barkin RM, Schaider JJ, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2019 April 25]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307321/all/Testicular_Torsion.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Testicular Torsion ID - 307321 ED - Rosen,Peter, ED - Shayne,Philip, ED - Barkin,Adam Z, ED - Wolfe,Richard E, ED - Hayden,Stephen R, ED - Barkin,Roger M, ED - Schaider,Jeffrey J, BT - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307321/all/Testicular_Torsion PB - Lippincott Williams & Wilkins ET - 5 DB - Emergency Central DP - Unbound Medicine ER -