We report the case of a patient presenting with the classic clinical appearance of testicular torsion. When the testicle twists on itself it causes the blood supply to kink and the testis does not receive the oxygen it needs to live. Occasionally, these attachments do not exist and the testicle can twist. Testicular torsion is an acute vascular event causing the rotation. An ultrasound test to examine the contents of the scrotum may help sort out the cause. Diagnosis is based on physical examination and confirmed by color doppler ultrasonography. Testicular torsion occurs when a testicle torts on the spermatic cord resulting in the cutting off of blood supply. Effect of unilateral testicular torsion on contralateral. Testis tissue survival after tt is dependent on the degree and duration of tt. Its imperative to seek immediate medical care if you have severe pain in a testicle. Intermittent testicular torsion in the pediatric patient.
Testicular torsion symptoms, diagnosis and treatment. Pdf torsion of the testis, also referred to as torsion of the spermatic cord, is a subject of debate among physicians and surgeons. Testicular torsion has an acute onset, often with no antecedent trauma. Pediatric testicular torsion clinical presentation. Intravaginal torsion involves twisting of the spermatic cord within the tunica vaginalis but does not include the tunica vaginalis and more commonly affects the left side basta et al. Testicular torsion tt is a true urologic emergency and must be differentiated from other causes of acute testicular pain because a delay in diagnosis and management can lead to loss of the testis and infertility. Arrangements for a doppler ultrasound could not be made over the weekend and so the patient was discharged with painkillers.
Describe the role of imaging in penile emergencies, such as fracture, priapism, and mondor disease. Testicular torsion can affect males at any age but boys usually aged between 12 to 18 years are at greater risk of intravaginal torsion than other age groups. Trainor, md because acute scrotal pain, swelling, andor inflammation are a potential surgical. There is thought to be a possible genetic basis for predisposition to torsion, based on multiple published reports of familial testicular torsion. Time urgency in ovarian versus testicular torsion asfour. Androgen insensitivity syndrome genetic disorder britannica. Testicular torsion is often a challenging diagnosis to make, yet it is one that must be actively excluded in every presentation of acute scrotal pain. Jul 02, 2019 pediatric testicular torsion is an acute vascular event in which the spermatic cord becomes twisted on its axis see the image below, so that the blood flow to or from the testicle becomes impeded. As a result, blood is unable to flow to the testicle and scrotum, which can lead to tissue death.
Testicular torsion occurs when a testicle rotates, which twists the spermatic cord that carries blood to the scrotum. The testicle has attachments that hold it in place in the scrotum. The extent and duration of torsion influences the immediate salvage rate and late testicular atrophy testicular salvage most likely occurs if the duration of torsion is less than 6less than 68 hours8 hours 8 hours. It is considered a surgical emergency, as a delay causes irreversible testicular damage. Androgen insensitivity syndrome ais is an xchromosomelinked recessive disorder, being caused by a mutation. Testicular torsion may also be caused by trauma to the scrotum or exercise in particular, bicycle riding, however only about 48% of cases are the result of trauma. The following are the 2 most common types of testicular torsion see image below. When not treated quickly, or at all, this condition can result in severe complications. Testicular torsion is a twisting of the spermatic cord and its contents and is a surgical emergency affecting 3.
Traumatismo escrotal y testicular etiologia trauma contuso. Testicular torsion occurs when the spermatic cord becomes twisted. In the setting of testicular torsion, normal testicular echogenicity is a strong predictor of viability. This is a painful condition caused by the twisting of the spermatic cord, which causes a loss of blood flow to the testicle.
This causes a restriction in blood flow to the testes, severe pain, and possibly permanent damage. Common testicular problems and what to do about them. An update on the diagnosis and management of ovarian torsion. Dec 04, 20 he sent the patient to the emergency department with a referral letter which queried testicular rupture. Factors associated with delayed treatment of acute testicular torsion do demographics or interhospital transfer matter. Patients scrotal examination was misleading because both testes were retracted. This is a urologic emergency that affects one in 4000 males younger than 25 years annually and results in an orchiectomy 42% of the time in those undergoing surgery for testicular torsion. Urologia practica 2011 traumatismo escrotal y testicular. Testicular torsion and risk factors for orchiectomy. An update on the diagnosis and management of ovarian torsion emmanuel damigos ptychio latrikes mbbs,a jemma johns mbbs md mrcog,b, jackie ross mbbs frcog c ast5 in obstetrics and gynaecology, friarage hospital, south tees hospitals trust, northallerton, north yorkshire dl6 1jg, uk bconsultant gynaecologist, kings college hospital, denmark hill, london se5 9rs, uk. Testicular cancer is one of the most curable cancers when found early.
Testicular torsion occurs when the testicle twists around the spermatic cord, resulting in blood flow to the testicle being compromised. Manual detorsion is contraindicated if the duration of torsion is more than 6 hours. Testicular torsion outside of the perinatal period is a surgical emergency and emergent pediatric urology consultation is recommended. It accounts for 10% to 15% of acute scrotal disease in children, and results in an orchiectomy rate of 42% in boys undergoing surgery for testicular torsion. Testicular torsion occurs when the spermatic cord from which the testicle is suspended twists, cutting off the blood supply to the testicle. Immediate treatment is needed to prevent loss of the testicle and infertility.
Testicular torsion genitourinary disorders merck manuals. Under certain circumstances, a testicular cancer or tumor can present with symptoms similar to a testicular torsion. If 24 hours or more elapse, testicular necrosis develops in most patients. While epididymoorchitis and testicular torsion are the most common causes of abnormalities at scrotal us, abnormal testicular doppler flow may be caused by extrinsic testicular or spermatic cord compression or intrinsic abnormalities from infection, inflammation, or atrophy. Frecuente en urgencias urologicas importantes repercusiones a largo plazo. After onset of puberty most of the testicular tumors are malignant. Bilateral simultaneous testicular torsion presenting as a. When this condition is treated quickly, the testicle can usually be saved. Ultrasonography is helpful to rule out testicular torsion. The 16yearold patient presented with a 3 h history of left hemiscrotal pain, nausea and vomiting. Torsion of the testicle it is time to stop tossing the dice larry b. Methamphetamine use can mimic testicular torsion doherty.
Trauma induced testicular torsion is a well recognised entity, the incidence being 48% in most studies reporting on testicular torsion. It could be either within or outside the tunica vaginalis. It is an abnormal collection of serous fluid located between the visceral and parietal layers of the tunica vaginalis, but also may be adjacent to the spermatic cord. The impact of testicular torsion on testicular function. His comorbidities included digeorge syndrome 22q11 deletion syndrome. Testicular torsion is an emergency requiring immediate care.
Medicolegally, we believe that an operative delay of up to 8 hours is probably safe when considering the causation of testicular loss, but more data are needed. Androgen insensitivity syndrome ais, rare genetic disorder in which a genetically male individual fails to respond naturally to the effects of male hormones also known as androgens. This reduced blood flow causes sudden, often severe pain and swelling. Men need to see a doctor if they find any difference between their testicles or if they are in a high risk group. Testicular torsion is the most common cause of acute scrotal pain in the prepuberal and adolescent boys and should be foremost in the minds of primary care physicians evaluating these children. Testicular torsion should always be considered as one of the main causes of acute scrotal pain. Increasing testicular and epididymal congestion promotes progression of torsion.
Ultrasound showed testicular ischemia supporting the clinical diagnosis, but the lack of visualization of spermatic cord torsion was of concern. Testicular torsion causes immediate circulatory changes and longterm sequelae such as. Emergency department approach to testicular torsion. Mar 01, 2017 testicular torsion beyond the neonatal period 1 month of age and older is an intravaginal torsion. A 31yearold male who had previous testicular fixation for testicular torsion with a single stitch to the lower pole before 6 years presented with. If you continue browsing the site, you agree to the use of cookies on this website. Usually, the testicle is held in place by surrounding tissue, but some boys dont have enough anchoring tissue, allowing the testicle to move freely and twist within the. Intermittent testicular torsion in the pediatric patient resolution. Testicular torsion causes immediate circulatory changes and longterm sequelae such as testicular function and fertility. A paratesticular mass may derive from a number of structures that surround the testicle within the scrotum. The sixhour rule for testis fixation in testicular.
Distinguishing testicular torsion from torsion of the appendix testis by clinical features and signs in patients with acute scrotum naoyuki fujita,1 mitsuhiro tambo,1 takatsugu okegawa,1 eiji higashihara,2 kikuo nutahara1 1department of urology, 2department of autosomal dominant polycystic kidney disease adpkd research, kyorin university school of medicine, mitaka, tokyo purpose. When findings support or raise suspicion of spermatic cord torsion, emergent scrotal exploration is indicated and should not be delayed. The testicle has attachments that hold it in place in the. Bilateral simultaneous testicular torsion is a rare condition and can be misdiagnosed. Doctors help you with trusted information about pain in testicular torsion. The testicle may be higher than usual in the scrotum and vomiting may occur. Apr 15, 2020 testicular torsion is a surgical emergency that may result in the loss of the affected testicle if not treated promptly. Chqgdl600001 acute scrotal pain emergency management in children 4 investigations alert delays to detorsion increase the risk of testicular infarction. The signs and symptoms of testicular torsion may easily be mistakenly attributed to preceeding testicular trauma if there was such an event. Careful examinations of severe damage to the seminiferous epithelium after repair of unilateral torsion have never shown a significant contralateral effect on spermatogenesis 20 or even on a number of other. The dynamed team systematically monitors clinical evidence to continuously provide a synthesis of the most valid relevant evidence to support clinical decisionmaking see 7step evidencebased methodology guideline recommendations summarized in the body of a dynamed topic are provided with the recommendation grading system used in the original guidelines, and allow users to quickly. An attempt of clinical detorsion was considered unsuccessful and the patient was explored.
Surgical exploration is indicated out to 24 hours, however, given that testes can still be saved and that the degree of torsion cannot be gleaned preoperatively. Feb 08, 20 i have been told by two urologists that i probably have intermittent testicular torsion. Any patient presenting with acute scrotal pain and a mass or swelling should be urgently evaluated for testicular torsion because timely diagnosis is key to preserving testicular function. Testicular torsion is a urological emergency that can result in ischemia and necrosis of the testicular tissue, commonly in young males and adolescents. Dont let embarrassment get in the way of seeing your doctor and discussing the issue of testicular cancer.
The cause of testicular cancer is unknown, but most of them originate in the. The reason for this is that testicles have a higher metabolic. Key points testicles should be palpable in the scrotum by 6 months of age. The aim of this study was to investigate the function of the contralateral testis after unilateral testicular torsion utt and its possible mechanism. Testicular torsion is an emergency condition due to rotation of the testis and consequent strangulation of its blood supply. The most common symptom in children is sudden, severe testicular pain. Testicular torsion can happen in all ages, but usually happens in boys ages 1216 about 65% of all testicular torsion or as a young baby also called neonatal torsion. Acute scrotal pain emergency management in children.
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. Testicular torsion american pediatric surgical association. The most common symptom is acute testicular pain and the most common underlying cause, a bellclapper deformity. Boys who are having pain in the testicles always need prompt medical. This case showed that this diagnosis can occur even when the testis is still fixed to the scrotal wall. Identify the color doppler us findings of testicular torsion, rupture, and lowflow priapism, all of which require immediate treatment. A patient is described with trauma induced testicular torsion who presented on three occasions before a decision was. This occurs because there may be some bleeding into a testis cancer which can cause the same type of pain and swelling as a torsion of the testis.
To report our experience and present the largest series of testicular torsion cases in the inguinal canal. On admission the patient was noted to be suffering from intermittent testicular pain and the diagnosis was unclear. Manual detorsion is performed without local or general anesthesia. Partial testicular torsion and torsiondetorsion syndrome. Testicular torsion is a true surgical emergency because testis viability is inversely related to the duration of torsion. Full text distinguishing testicular torsion from torsion. Dec 15, 20 summary for patients in am fam physician. Pathology the masses can be categorized as benign 70% or malignant 30%.
A surgical examination of the affected side is recommended and contralateral orchiopexy, due to the risk of presenting with contralateral asynchronic testicular torsion11, 12. Jan 24, 2016 testicular salvage is most likely if the duration of torsion is less than 68 hours. Varicocele is an enlarged vein within a testicle, similar to a varicose vein. Testicular torsion is a known urological emergency. Prompt diagnosis remains difficult and testicular salvage rates depends on the interval between symptom onset and the surgical treatment. Recurrent testicular torsion after previous orchiopexy is rare and needs high index of suspension to avoid misdiagnosis and delayed management. Pdf factors associated with delayed treatment of acute. Complete torsion is a medical emergency that could result in loss of the testicle if it is not repaired within 46 hours. This causes interruption of the blood supply, which can rapidly lead to permanent damage to the testicle. Testicular torsion is a condition that involves twisting of the testicle and the spermatic cord from which it is suspended. The condition is mainly related to a congenital condition due to a bell clapper deformity that causes the testicle to twist suddenly around its cord leading to testicular ischemia and possibly infarction. Classically, testicular torsion presents with sudden onset, severe scrotal pain with associated swelling, nausea and vomiting.
It provides information on testicular cancer, the treatment and management options, the impact of these treatments. Testicular torsion pediatrics clerkship the university of. Following the exclusion of testicular torsion, other nonemergent diagnosis of acute scrotal pain may be. Testicular torsion is a urologic emergency caused by the twisting of the testicle on the spermatic cord leading to constriction of the vascular supply and timesensitive ischemia andor necrosis of testicular tissue. Symptoms are acute scrotal pain and swelling, nausea, and vomiting. Within the scrotum, the testicles are secured by a structure called the spermatic cord, which contains an anchoring tissue called the gubernaculum at the lower part of. Testicular torsion refers to twisting of the spermatic cord structures, either in the inguinal canal or just below the inguinal canal. Diagnosis and management of testicular torsion, torsion of. 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 a medical emergency, so youll need to immediately go to the doctor if you have it. The incidence rate and characteristics in patients with testicular torsion. Testicular torsion pain level what doctors want you to know. Immediate surgical detorsion in these patients carries a very high likelihood of salvaging the affected testis. Testicular torsion symptoms, surgery, treatment, causes.