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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