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Torsion of the testis, also referred to as torsion of the spermatic cord, is a subject of debate among physicians and surgeons. Testicular torsion is an acute vascular event causing the rotation of the vascular pedicle of the testis, thereby impeding the blood flow to the testis and the scrotal contents. It could be either within or outside the tun...
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Torsion of the testis, also referred to as torsion of the spermatic cord, is a subject of debate among physicians and surgeons. Testicular torsion is an acute vascular event causing the rotation of the vascular pedicle of the testis, thereby impeding the blood flow to the testis and the scrotal contents. It could be either within or outside the tun...
Context
Testicular torsion, the twisting of the testis or spermatic cord, places the testis at risk of vascular compromise and is a surgical emergency. Testicular torsion is predominantly unilateral (98% of torsion cases) and primarily affects neonates and adolescents in a bimodal distribution. Bilateral testicular torsion is exceedingly rare (2% o...
Background
Testicular torsion is the reduction of blood flow to the testis after spermatic cord torsion. For patients, the diagnosis of testicular torsion is controversial and complicated by the fact that ultrasound blood flow signals are not significantly reduced in comparison to the unaffected, healthy, testis, despite persistent symptoms on the...
Introduction: Testicular torsion is a twisting of the spermatic cord, which results in impaired blood flow to the testicle. This urological emergency occurs 3.8 per 100,000 males annually, most often observed younger than 18 years. The left testis is more frequently involved. Bilateral cases report for 2% of all torsions. We describe a male with a...
Background To investigate the diagnostic characteristics of high-frequency ultrasound with color doppler flow signal in pediatric testicular torsion to increase the diagnostic accuracy.
Methods Seven pediatric patients from October 2017 to August 2019 with preserved blood flow signal but surgically diagnosed as testicular torsion were retrospective...
Citations
... Generally speaking, testicular torsion treated within 6 hours after the beginning of symptoms results in approximately 90% to 100% testicular salvage, between 6 and 12 hours results in about 50% testicular salvage, and between 12 to 24 hours only about 10% of testes may be rescued 2,4 .Traditionally, a history and physical examination are used to diagnose testicular torsion. Testicular torsion pain often starts suddenly, as in acute vascular accidents, and is followed by nausea, vomiting, and scrotal edema 5 .Torsion's degree and duration can affect how abrupt onset scrotal or abdominal pain manifests, though 6 .Characteristic physical examination findings include a high riding testis with an abnormally horizontal orientation, a thicker cord, and an absence of the ipsilateral cremasteric reflex 2,4 . Testicular torsion, to prevent the loss of the testes permanently, it must be detected within 4 to 8 hours and treated surgically; after this time, the kid will experience decreased fertility and a high orchiectomy rate. ...
Background: Any delay in diagnosis, surgical intervention, or referral might irreparably damage the testicles since testicular torsion is an emergency vascular accident brought on by the spermatic cord spinning, which blocks the blood supply to the testis.
... Testicular torsion is a surgical emergency due to rotation of the vascular pedicle of the testis around its axis, preventing blood flow to the testis and scrotal contents [1]. Typically, it presents spontaneously as a large, painful, acute bursa in an adolescent or young adult [2]. ...
Abstract Testicular torsion is a surgical emergency caused by rotation of the vascular pedicle of the testicle around its axis. If left untreated, testicular necrosis can set in, necessitating orchiectomy and loss of the testicle. The authors of this article reviewed articles on testicular torsion published in sub-Saharan Africa. The aim of this work is to establish the patient profile, consultation delay and orchiectomy rate in the sub-Saharan context. Data from the review will be compared with large non-sub-Saharan series and journals. Twenty-three articles were selected for review. All these articles were published between 1985 and 2022. A total of 1410 patients were included in the review. The average age was 19.7 years. The majority of patients were from urban areas. Risk factors for torsion were identified in 9 publications. The mode of hospital admission varied. Acute scrotal pain was the main symptomatology reported. The mean time in hours between onset of symptoms and consultation was 52.5 h. The left side was affected in 46.04% and the right in 49.81%. Four authors reported referral to a health center, and 8 authors reported scrotal ultrasonography. The rate of orchiectomy performed was found in 21 publications, the mean for the review as a whole was 46.4% with extremes of 13.2 and 72%. The orchiectomy rate was 52.4% in studies that reported an initial referral to a health center (patient transfer), versus 36.9% in studies that did not. In studies reporting ultrasound, the orchiectomy rate was 52.5%, compared with 36.9% in those not reporting ultrasound. On the basis of these results, we can formulate the following recommendations and actions: (i) further study of this pathology in sub-Saharan countries; (ii) raise public awareness of this pathology; (iii) train and retrain community workers and health center managers; and (iv) train general practitioners and surgeons in emergency scrototomy, orchidopexy and orchidectomy.
... The ischemia of the reproductive organs largely occurs in the testicles of males and the ovaries of females. Testicular torsion is the primary cause of testicular ischemia and commonly occurs in neonates and adolescents [169,170]. Ovarian ischemia is usually caused by ovarian torsion, surgery, and pregnancy [171]. Long-term ischemia of the testis and ovaries can lead to cell damage and declined function, resulting in hormone secretion disorders, low fertility, and infertility [172]. ...
Tissue and organ ischemia can lead to cell trauma, tissue necrosis, irreversible damage, and death. While intended to reverse ischemia, reperfusion can further aggravate an ischemic injury (ischemia-reperfusion injury, I/R injury) through a range of pathologic processes. An I/R injury to one organ can also harm other organs, leading to systemic multiorgan failure. A type of carotenoid, lycopene, has been shown to treat and prevent many diseases (e.g., rheumatoid arthritis, cancer, diabetes, osteoporosis, male infertility, neurodegenerative diseases, and cardiovascular disease), making it a hot research topic in health care. Some recent researches have suggested that lycopene can evidently ameliorate ischemic and I/R injuries to many organs, but few clinical studies are available. Therefore, it is essential to review the effects of lycopene on ischemic and I/R injuries to different organs, which may help further research into its potential clinical applications.
... The ischemia of the reproductive organs largely occurs in the testicles of males and the ovaries of females. Testicular torsion is the primary cause of testicular ischemia and commonly occurs in neonates and adolescents [169,170]. Ovarian ischemia is usually caused by ovarian torsion, surgery, and pregnancy [171]. Long-term ischemia of the testis and ovaries can lead to cell damage and declined function, resulting in hormone secretion disorders, low fertility, and infertility [172]. ...
Tissue and organ ischemia can lead to cell trauma, tissue necrosis, irreversible damage, and death. While intended to reverse ischemia, reperfusion can further aggravate an ischemic injury (ischemia-reperfusion injury, I/R injury) through a range of pathologic processes. An I/R injury to one organ can also harm other organs, leading to systemic multiorgan failure. A type of carotenoid, lycopene, has been shown to treat and prevent many diseases (e.g., rheumatoid arthritis, cancer, diabetes, osteoporosis, male infertility, neurodegenerative diseases, and cardiovascular disease), making it a hot research topic in health care. Some recent researches have suggested that lycopene can evidently ameliorate ischemic and I/R injuries to many organs, but few clinical studies are available. Therefore, it is essential to review the effects of lycopene on ischemic and I/R injuries to different organs, which may help further research into its potential clinical applications.
... [9] There is no consensus on the exact algorithm to be followed in patients with suspected torsion. [10] Even an experienced clinician cannot make a clear-cut clinical distinction between testicular torsion and epididymo-orchitis with full assurance. [8] The conventional evaluation of patients with likely testicular torsion has been clinical evaluation followed by an urgent scrotal ultrasound scan and immediate surgical exploration and detorsion as testicular torsion is a vascular emergency. ...
... After 12 h, the probability of testicular salvage becomes very low. [10] Following the exposure of the testis via an incision on the scrotum and the tunica vaginalis, the testis is detorsed and wrapped in a warm gauze. ...
Blunt scrotal trauma results in different forms of injuries such as hematoma, rupture of the testis, and testicular torsion. The diagnosis of trauma-induced testicular torsion in patients with blunt scrotal trauma requires a high index of suspicion. As early diagnosis and management of traumatic testicular torsion obviate testicular losses, an urgent testicular scan is necessary in cases of suspected traumatic torsion, and if not readily available or indeterminate, scrotal exploration is promptly indicated. Reported herein is a case of traumatic testicular torsion which was managed as a straightforward blunt scrotal trauma in a private health facility. He eventually had an orchidectomy when he presented to us 4 months later on account of a marked reduction in testicular volume. This case report reiterates the need to look beyond the obvious in patients with blunt scrotal trauma and the necessity of testicular scan and scrotal exploration in testicular salvage in suspected trauma-induced testicular torsion.
... [9] There is no consensus on the exact algorithm to be followed in patients with suspected torsion. [10] Even an experienced clinician cannot make a clear-cut clinical distinction between testicular torsion and epididymo-orchitis with full assurance. [8] The conventional evaluation of patients with likely testicular torsion has been clinical evaluation followed by an urgent scrotal ultrasound scan and immediate surgical exploration and detorsion as testicular torsion is a vascular emergency. ...
... After 12 h, the probability of testicular salvage becomes very low. [10] Following the exposure of the testis via an incision on the scrotum and the tunica vaginalis, the testis is detorsed and wrapped in a warm gauze. ...
... [2,3] Prompt referral to a urologist is recommended [4] to maximize the chances of testicular survival. [5,6] Testicular loss in sub-Saharan Africa is directly related to late presentation, missed diagnosis, and delay in the referral at the point of the first contact with health workers. [7,8] In recent times, our health facility has experienced a high rate of testicular losses from misdiagnosis and delayed referral of patients with acute scrotum from referring health facilities. ...
... [1,2] Testicular torsion is a urological emergency that affects any age group but most common in the second and third decades of life. Pentyala et al. [6] reported a peak age range of 12-18 years while Magoha [10] in a study of 81 testicular torsion patients in Lagos reported a mean age of 21.3 years. Although the majority of the health care workers in this study have heard of and knew the meaning of testicular torsion [ Table 2], about one-third does not know that testicular torsion is an emergency while only about 41% know the age group most affected. ...
... [13] However, the presentation of sudden-onset scrotal or abdominal pain may vary according to the extent and duration of torsion. [6] A high-riding testis in an abnormal horizontal orientation with thickened cord and an absent cremasteric reflex on the ipsilateral side are characteristic findings on physical examination. [1,2,13] One-fifth of our study participants could not demonstrate a good knowledge of the symptoms and signs of testicular torsion. ...
Objectives
Testicular torsion is the twisting of the spermatic cord with attendant loss of the blood supply to the affected testis. It is a common urological emergency and one of the frequent causes of acute scrotum in adolescents and young adults. Prompt diagnosis and immediate surgical intervention are necessary for testicular salvage. Testicular loss is directly linked to delay in presentation, surgery, and the referral patterns at the point of the first contact with health-care providers. The purpose of our study is to assess the knowledge, management methods, and referral pattern among health care workers in the primary health-care facilities in Auchi primary health-care zone, Nigeria.
Material and Methods
This was a cross-sectional carried out among primary health care workers in Auchi primary health-care zone between May and October 2020. A structured self-administered questionnaire was given to all the first contact health care workers in this zone. The knowledge, management, and referral pattern of testicular torsion were determined based on responses to the questionnaires. Data were analyzed using SPSS version 21. Results were displayed with frequency distribution tables and charts.
Results
Eighty-seven health care workers met the inclusion criteria and were given questionnaires to fill. The mean age of the respondents was 37.74 ± 7.53 years. The majority of the health workers ( n = 66, 75.9%) have more than 5 years’ experience with only 12 (13.8%) having a secondary level of education. Most respondents have heard of testicular torsion ( n = 77, 88.5%) and know the symptoms ( n = 68, 78.2%) but they have a poor knowledge of the age group predominantly affected ( n = 36, 41.1%) and testicular survival time following torsion (n= 41, 47.7%). Only about a third ( n = 28, 32.2%) had attended to patients with testicular torsion. Of the 28 health workers who had managed patients with testicular torsion, less than half ( n = 11, 39.3%) referred almost immediately, while about half treated conservatively ( n = 14, 49.9%) keeping the patients under their care for a period of 3–7 days.
Conclusion
This study showed that a comprehensive education of all categories of health workers in the primary health-care centers is needed. This is necessary for the early identification and appropriate surgical intervention or prompt referral of patients with testicular torsion to prevent avoidable testicular losses.
... Pathology of surrounding structures such as rupture of the tunica albuginea, spasm of the cremasteric muscle, torsion of the spermatocele, hydrocele and pyocele may also present with an acute scrotum. 23 Testicular pathologies that may mimic testicular torsion include torsion of testicular appendages, epididymo-orchitis, mumps orchitis, testicular infarct, polyorchidopathia, trauma, ischemic necrosis, tumour-related hemorrhage and myofibroblastic pseudotumor. An infarcted spermatic chord, hematoma and thrombophlebitis associated with varicocele represent conditions affecting the spermatic cord which may mimic testicular torsion. ...
... Abdominal and retroperitoneal pathologies such as incarcerated strangulated hernia, pancreatic tumour, hemoperitoneum, acute appendicitis, and rarely adrenal hemorrhage in neonates can also mimic testicular torsion. 23 Torsion of the testicular appendages and epididymoorchitis is the most common mimics of testicular torsion. 24 Clinical characteristics of these pathologies are described in Table 1. ...
... In the suspected diagnosis of torsion, urgent scrotal exploration is the treatment of choice to salvage a possible ischemic testis. 23 Non-viable testis should be removed (orchiectomy) to prevent formation of anti-sperm antibodies and thus compromising the functionality of the healthy contralateral testis. Testicular viability during surgical exploration can be determined on clinical grounds in most instances. ...
Testicular torsion is a challenging and time-sensitive diagnosis that is encountered frequently in daily practice, especially in the emergency room. A thorough history, the presence of a painful and swollen testis and testicular ultrasonography plays a vital role in the prompt diagnosis of testicular torsion. Prompt diagnosis is essential to prevent complications of testicular torsion which include testicular infarction, necrosis, and sub/infertility. This can be challenging as there are various other conditions that may mimic the presentation of testicular torsion. Since testicular torsion is an extremely time-sensitive diagnosis, it may also be a subject of many medicolegal challenges. This review article serves as a guide for clinicians involved with the diagnosis and management of testicular torsion. We review and discuss detection and management strategies based on their validity, statistical significance, and effectiveness in enabling prompt diagnosis and management of testicular torsion. Medicolegal implications of testicular torsion are also highlighted.
... It is indicated that a simple orchiectomy has to be done in late cases, which may cause infertility due to loss of function in the contralateral testes [3]. Although we do not clearly know how and when irreversible changes begin in the testes, intervention or detorsion surgery is recommended to be done in 4-6 h [4]. ...
Objective:
Testicular torsion causes migration of neutrophils to the ischemic region and formation of free oxygen radicals that have a critical effect on ischemic reperfusion (I/R) injury. Udenafil is a selective, strong, and reversible inhibitor of phosphodiesterase type enzyme. In our study, we evaluate the protective effect of udenafil against reperfusion injury due to I/R.
Materials and methods:
Twenty-one male, adult, Wistar-Albino rats aged 8 months were randomly divided into three groups; sham, I/R, and I/R+udenafil. One hour before the detorsion operation, the sham and I/R groupssaline, and I/R+udenafil groups were administered 2 mg/kg udenafil intraperitoneally. Blood samples were collected to evaluate the inflammatory mediators. Spermatogenic factors were evaluated according to Johnsen criteria.
Results:
Histopathological and molecular parameters from all groups were compared. Mean values of TNF-α and IL-1β in venous blood samples were calculated. We observed that TNF-a values were statistically significantly increased in the I/R group than those in sham groups, and these values were decreased with udenafil treatment Furthermore, the glutathione peroxidase (GPx) level was statistically significantly decreased in the I/R group, and treatment with udenafil prevented this decrease. Evaluation of spermatogenesis using the Johnsen scoring system showed no statistically significant difference in mean scores between the groups.
Conclusion:
We concluded that deterioration of biochemical and histopathological parameters are reversed, and injury due to I/R in testicle tissue may be decreased with udenafil treatment. Results of this experimental study show that efficacy of the udenafil treatment in testis torsion should be investigated.
... Patients usually present with acute severe scrotal pain sometimes associated with nausea and vomiting. These catastrophe must be treated promptly to save the involved testis as it causes a decreased or even complete loss of blood flow to the affected testis 1 . It commonly occurs at puberty between 12-18 years of age, although there is also a peak during the neonatal period 2 . ...
Objective: Acute testicular torsion is a urological emergency that require quick accurate diagnosis and timely surgical intervention to salvage the testis. Nature of surgical management depending on viable or non viable testis during surgical exploration. Materials and methods: This retrospective study was conducted at some private hospital in Dhaka city and Comilla from June 2006 to February 2011. The study enrolled 36 patients with age range 7 to 23 years, mean age was 14 years. Twenty one (58.33%) patients reached hospitals within 4 to 6 hours from onset of pain, 7(19.44%) patients within 12 hours, 3(8.33%) patients within 24 hours, 2(5.55%) patients within 2 days and 3(8.33%) patients after 5 days of onset pain. All patients underwent surgical exploration. Results: Twenty four (66.66%) patients showed viable testis on exploration and orchidopexy were done on ipsilateral testis with prophylactic orchidopexy on contralateral site. Another 12 (33.33%) patients had nonviable testis, required orchidectomy on involved testis and prophylactic orchidopexy on opposite testis. Conclusion: Spermatic cord torsion represents a commonly encountered urological emergency where accurate diagnosis and timely intervention are essential for functional and nonatrophied testicular salvage. Bangladesh Journal of Urology, Vol. 15, No. 1, Jan 2012 p.3-5
