Urology: Testicular Torsion

Testicular Torsion

Definition

  • Testis Twists on the Spermatic Cord & Occludes Blood Supply
  • Surgical Emergency

Pathophysiology

  • Most Commonly Twists Toward Midline
  • Degree of Twisting Can Be 180-720 Degrees
  • Peak Incidence at 15 Years Old
  • Can Cause Permanent Injury After 8 Hours
  • Can Cause Infertility (Even if Contralateral Testis is Normal)

Causes

  • Trauma
  • Vigorous Physical Activity
  • Spontaneous

Presentation

  • Acute Severe Testicular Pain
  • Firm/Swollen Testicle
  • Nausea/Vomiting
  • Horizontal Lie of Testicle (“Bell Clapper” Deformity)
  • Asymmetric High-Riding Testicle
  • Absent Cremasteric Reflex

Diagnosis

  • Generally Made on Physical Exam
  • Doppler US Can Confirm

Treatment

  • Initial Step: Immediate Detorsion in the ED
  • Definitive Treatment: Bilateral Orchiopexy
    • Deficient Fixation of the Gubernaculum is Generally a Bilateral Deficit with High Risk for Future Contralateral Torsion
    • Torsion > 6 Hours Should Consider Incision of the Tunica Albuginea to Prevent Testicular Compartment Syndrome

Testicular Torsion 1

Testicular Torsion on US: Left Testicle Enlarged with Absent Flow on Doppler 2

References

  1. Shrivastava NS, Gopalaswamy C, Venugopal RM. Prenatal torsion of testis: a rare emergency. J Neonatal Surg. 2012 Apr 1;1(2):30. (License: CC BY-3.0)
  2. Kühn AL, Scortegagna E, Nowitzki KM, Kim YH. Ultrasonography of the scrotum in adults. Ultrasonography. 2016 Jul;35(3):180-97. (License: CC BY-NC-3.0)