Testicular torsion is a twisting of the testis on the spermatic. Testicular torsion presents with the rapid onset of severe testicular pain and swelling. Testicular torsion is a known urological emergency. He is an indian boy from mumbai, an excellent student at one of englands prestigious secondary colleges. Occasionally, these attachments do not exist and the testicle can twist. Early diagnosis and definitive management are the keys to avoid testicular loss. Torsion can occur at any time, while sitting or standing, or may awaken an individual from sleep. Cremasteric contraction, which is occur more than normal inside of the uterus, causing the torsion by increasing mobility layers of tunica vaginalis 1,5. The aim of this study was to investigate the function of the contralateral testis after unilateral testicular torsion utt and its possible mechanism. Pdf an evaluation of testicular torsion management in. Testicular torsion should always be considered as one of the main causes of acute scrotal pain.
This case showed that this diagnosis can occur even when the testis is still fixed to the scrotal wall. 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. Effect of unilateral testicular torsion on contralateral. Testicular torsion occurs when a testicle rotates, twisting the spermatic cord that brings blood to the scrotum. Each year, testicular torsion affects one in 4,000 males younger than 25 years. Torsion testicular en pediatria, diagnostico y manejo. The presence of intratesticular flow does not exclude testicular torsion.
The condition is treated as an emergency because the preservation of the testicle and ultimately fertility is dependent on early diagnosis and treatment. 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. Its management is controversial, due to the low viability of the testis and the possibility of bilateral torsion. The reduced blood flow causes sudden and often severe pain and swelling. Testicular torsion beyond the neonatal period 1 month of age and older is an intravaginal torsion. Is prenatal testis torsion unsalvageable event acad j ped neonatol. Testicular torsion is a twisting of the spermatic cord and its contents and is a surgical emergency affecting 3. 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 is one of the most common reasons for the loss of a testicle before puberty. The spermatic cord supports the testes in the scrotum. It most often occurs in children or adolescents, but this diagnosis should be considered in evaluating men with scrotal pain of any age, as it may. When this happens there is a loss of blood supply to the ipsilateral testicle 1. A lack of blood makes the affected testicle swell up and become painful.
It could be either within or outside the tunica vaginalis. Testicular torsion is defined as the torsion of the spermatic cord structures. Suppurative appendicitis presenting acute scrotal pain. When the cord twists, the blood supply to the testicle is cut off. Acute scrotal pain emergency management in children. Pdf missed painless testicular torsion in adult patient. All prepubertal and young adult males with acute scrotal pain should be considered to have testicular torsion until proven otherwise.
Testicular torsion has been reported to have a bimodal distribution, an initial peak in the first year of age where the torsion is of extravaginal type, and a second surge in adolescence where intravaginal torsion is common. He checked online and suspected he might have a testicular torsion. Testicular torsion happens when the spermatic cord becomes twisted. Revista pediatria electronica torsion testicular en pediatria. Testicle, testicular torsion, acute scrotal syndrome. Testicular torsion twisting is a common urological emergency in adolescents and young men twisting of the testicle can result in permanent damage or loss of the testicle if not treated promptly your other testicle will need to be fixed permanently in the scrotum, at the same time, to prevent it ever twisting in the future.
Recent studies have found the relative risk rr of developing testicular cancer in a boy with udt is 2. Testicular torsion occurs mainly in two different age. To compound the diagnostic dilemma, pathologies such as testicular torsion are time sensitive with a delay in diagnosis being potentially catastrophic to the young male. A number of diagnoses can present with acute scrotal pain including testicular torsion and incarcerated inguinal hernia which require timecritical diagnosis to avoid permanent harm. One of the commonest differentials for the acute scrotum is an epididymoorchitis eo, which can mimic the presentation of testicular torsion. However, it also occurs with torsion of the testicle and the testicular appendage. Surgical testicular torsion was induced for 2 h, followed by detorsion which was continued for 24 h. Each dose was given twice, the first 30 min before and the second 12 h after testicular detorsion. Testicular torsion occurs when the spermatic cord from which the testicle is suspended twists, cutting off the blood supply to the testicle.
Combining bmode and power doppler imaging facilitates a. While it usually occurs in postpubertal boys, it can be seen in a range of ages from neonates to young men. Ultrasonography is the method of choice to study testicular torsion. The finding of an ipsilateral absent cremasteric reflex is the most accurate sign of testicular torsion. The most common symptom in children is sudden, severe testicular pain. Testicular torsion occurs when the spermatic cord becomes twisted.
Testicular torsion is a twist of the spermatic cord leading to cessation of testicular blood flow, ischaemia and infarction if left untreated occurs most often in the neonatal period and around puberty bimodal. Delayed diagnosis should be avoided and the patient should always be referred for a further level of treatment since its delay is directly related to the percentage of testicular salvage or loss fig. Torsion testicular, reto diagnostico ante una urgencia. Baicalin was administered in three different doses 25, 50 and 100 mg kg. The testicle has attachments that hold it in place in the scrotum. Testicular grayscale ultrasound is the modality of choice for the imaging evaluation of acute scrotal pain. Most are extravaginal, and intravaginal torsion is rare.
Factors associated with delayed presentation and misdiagnosis of testicular torsion. This causes a restriction in blood flow to the testes, severe pain, and possibly permanent damage. If i had tried to detorse, i would have created a torsed testicle. Testicular vascularity can look symmetrical with the contralateral asymptomatic side with preserved arterial and venous flow and still represent testicular torsion.
Testicular torsion also called testis torsion requires immediate surgery to save the testicle. The left testis tends to be more commonly affected. The prevalence of testicular torsion is one per 4000 males under 25 years of age blaivas et al. The onset of pain may be preceded trauma, physical activity, or by no activity e. Although neonatal torsion is a welldescribed complication in the neonatal period with an incidence of approximately 6. Trauma induced testicular torsion is a well recognised entity, the incidence being 48% in most studies reporting on testicular torsion. Torsion testicular, reto diagnostico ante una urgencia quirurgica.
The twisting cuts off the testicles blood supply and causes sudden pain and swelling. Testicular torsion is most common between ages 12 and 18, but it can occur at any age, even before birth. Distinguishing testicular torsion from torsion of the appendix testis by clinical features and sign in patients with acute scrotum. Recurrent testicular torsion after previous orchiopexy is rare and needs high index of suspension to avoid misdiagnosis and delayed management. Just click edit text or double click me and you can start adding your own content and make changes to the font. Fujita n, tambo m, okegawa t, higashihara e, nutahara k. It happens when the spermatic cord, which provides blood flow to the testicle, rotates and becomes twisted. The testicle may be higher than usual in the scrotum and vomiting may occur. A 31yearold male who had previous testicular fixation for testicular torsion with a single stitch to the lower pole before 6 years presented with. Testicular torsion is a highly disastrous complication if it is not corrected in a short time, and the solution that avoids the loss of the affected testicle is immediate surgical exploration.
Torsion testicular trastornos urogenitales manual msd version. An evaluation of testicular torsion management in the emergency department article pdf available december 2017 with 292 reads how we measure reads. Testicular cancer is rare, with an incidence around 4100 000 in canada. It also may occur during sports or physical exercise. Testicular torsion occurs when the spermatic cord twists around the. Torsion can slow or cut off blood flow to the testicle. Treatment involves rapid restoration of blood flow to the affected testis. The hallmark of testicular torsion is sudden, severe, onesided testicular pain. Acute scrotal pain is a common surgical emergency in boys. Testicular torsion causes immediate circulatory changes and longterm sequelae such as. 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. In newborns pain is often absent and instead the scrotum may become discolored or the testicle may.
Canadian urological associationpediatric urologists of. Pdf torsion of the testis, also referred to as torsion of the spermatic cord, is a subject of. Torsion of the testicular appendages in adult acute. Testicular torsion symptoms and causes mayo clinic. The signs and symptoms of testicular torsion may easily be. Testicular torsion is a surgical emergency testis viability can diminish considerably six hours after symptom onset. At age 17 years, the boy had been experiencing testicular pain intermittently over the few weeks prior to the recent christmas new year break. A presumptive diagnosis of testicular torsion should be made promptly on history and examination alone.