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Testicular Torsion

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Pediatric Urology

Abstract

Two primary goals in diagnosis and management of testicular torsion:

  1. 1.

    Preserve the ipsilateral testis, when it remains viable.

  2. 2.

    Prevent contralateral torsion.

Secondary goals include the following:

  1. 1.

    Avoidance of risk factors for infertility.

  2. 2.

    Maintain a normal scrotal appearance.

Evidence for these aims—perinatal torsion:

  • Most case series report no ipsilateral testis salvage from neonatal surgery. One reported 2 of 30 explored testes had normal size at follow-up.

  • Risk for contralateral postnatal torsion is not well defined, but case series report neonatal ultrasound to be unreliable to exclude vascular compromise.

  • Our review found no data regarding fertility or psychologic impact of asymmetric scrotal appearance after perinatal torsion.

Evidence for these aims—torsion in children and teenagers:

  • Few objective criteria are described to guide orchiopexy versus orchiectomy, and there is no agreed-upon definition for atrophy after orchiopexy.

  • Two retrospective studies that defined atrophy as ≥15 % or >50 % volume loss reported 27 and 13 % occurrence.

  • We found one case of simultaneous bilateral torsion, and none of asynchronous torsion, after the neonatal period. Contralateral orchiopexy is done based on potential risks.

  • One retrospective review reported recurrent torsion in 4 % of patients after orchiopexy.

  • There are few data regarding fertility in men after torsion. Semen analyses most often are normal, with oligospermia in 0–35 %. Antisperm antibodies reported in three studies were positive in only 2/80 patients.

  • Our review found no article regarding psychologic impact of orchiectomy or testicular atrophy after orchiopexy for torsion.

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References

  • Al-Hunayan AA, Hanafy AM, Kehinde EO, Al-Awadi KA, Ali YM, Al-Twheed AR, et al. Testicular torsion: a perspective from the Middle East. Med Princ Pract. 2004;13(5):255–9.

    Article  PubMed  CAS  Google Scholar 

  • Anderson MJ, Dunn JK, Lipshultz LI, Coburn M. Semen quality and endocrine parameters after acute testicular torsion. J Urol. 1992;147(6):1545–50.

    PubMed  CAS  Google Scholar 

  • Arap MA, Vicentini FC, Cocuzza M, Hallak J, Athayde K, Lucon AM, et al. Late hormonal levels, semen parameters, and presence of antisperm antibodies in patients treated for testicular torsion. J Androl. 2007;28(4):528–32.

    Article  PubMed  CAS  Google Scholar 

  • Arda IS, Ozyaylali I. Testicular tissue bleeding as an indicator of gonadal salvageability in testicular torsion surgery. BJU Int. 2001;87(1):89–92.

    Article  PubMed  CAS  Google Scholar 

  • Baker LA, Sigman D, Mathews RI, Benson J, Docimo SG. An analysis of clinical outcomes using color Doppler testicular ultrasound for testicular torsion. Pediatrics. 2000;105(3 Pt 1):604–7.

    Article  PubMed  CAS  Google Scholar 

  • Baker L. Feasibility of transscrotal near-infrared spectroscopy (NIRS) in the evaluation of acute scrotum: a pilot human study. American Urological Association Annual Meeting, Washington, DC, 2011.

    Google Scholar 

  • Barbosa JA, Tiseo B, Barayan GA, Rosman BM, Torricelli F, Passerotti CC, et al. Development and initial ­validation of a scoring system for diagnosing testicular torsion in children. J Urol. 2012. http://dx.doi.org/10.1016/j.juro.2012.10.056.

  • Bayne AP, Madden-Fuentes RJ, Jones EA, Cisek LJ, Gonzales Jr ET, Reavis KM, et al. Factors associated with delayed treatment of acute testicular torsion-do demographics or interhospital transfer matter? J Urol. 2010;184 Suppl 4Suppl 4:1743–7.

    Article  PubMed  Google Scholar 

  • Beni-Israel T, Goldman M, Bar Chaim S, Kozer E. Clinical predictors for testicular torsion as seen in the pediatric ED. Am J Emerg Med. 2010;28(7):786–9.

    Article  PubMed  Google Scholar 

  • Boettcher M, Bergholz R, Krebs TF, Wenke K, Aronson DC. Clinical predictors of testicular torsion in children. Urology. 2012;79(3):670–4.

    Article  PubMed  Google Scholar 

  • Bolln C, Driver CP, Youngson GG. Operative management of testicular torsion: current practice within the UK and Ireland. J Pediatr Urol. 2006;2(3):190–3.

    Article  PubMed  CAS  Google Scholar 

  • Brandt MT, Sheldon CA, Wacksman J, Matthews P. Prenatal testicular torsion: principles of management. J Urol. 1992;147(3):670–2.

    PubMed  CAS  Google Scholar 

  • Bush N, Bagrodia A. Initial results for combined orchiectomy and prosthesis exchange for unsalvageable testicular torsion in adolescents: description of intravaginal prosthesis placement at orchiectomy. J Urol. 2012;188 Suppl 4Suppl 4:1424–8.

    Article  PubMed  Google Scholar 

  • Ciftci AO, Senocak ME, Tanyel FC, Buyukpamukcu N. Clinical predictors for differential diagnosis of acute scrotum. Eur J Pediatr Surg. 2004;14(5):333–8.

    Article  PubMed  CAS  Google Scholar 

  • Cimador M, DiPace MR, Castagnetti M, DeGrazia E. Predictors of testicular viability in testicular torsion. J Pediatr Urol. 2007;3(5):387–90.

    Article  PubMed  Google Scholar 

  • Cornel EB, Karthaus HF. Manual derotation of the twisted spermatic cord. BJU Int. 1999;83(6):672–4.

    Article  PubMed  CAS  Google Scholar 

  • Creagh TA, McDermott TE, McLean PA, Walsh A. Intermittent torsion of the testis. BMJ (Clin Res Ed). 1988;297(6647):525–6.

    Article  CAS  Google Scholar 

  • Daehlin L, Ulstein M, Thorsen T, Hoisaeter PA. Follow-up after torsion of the spermatic cord. Scand J Urol Nephrol. 1996;179:139–42.

    CAS  Google Scholar 

  • Eaton SH, Cendron MA, Estrada CR, Bauer SB, Borer JG, Cilento BG, et al. Intermittent testicular torsion: diagnostic features and management outcomes. J Urol. 2005;174(4 Pt 2):1532–5. discussion 5.

    Article  PubMed  Google Scholar 

  • Favorito LA, Cavalcante AG, Costa WS. Anatomic aspects of epididymis and tunica vaginalis in patients with testicular torsion. Int Braz J Urol. 2004;30(5):420–4.

    Article  PubMed  Google Scholar 

  • Figueroa V, Pippi Salle JL, Braga LH, Romao R, Koyle MA, Bagli D, et al. Comparative analysis of detorsion alone versus detorsion and tunica albuginea decompression (fasciotomy) with tunica vaginalis flap coverage in the surgical management of prolonged testicular ischemia. J Urol. 2012;188 Suppl 4Suppl 4:1417–23.

    Article  PubMed  Google Scholar 

  • Gunther P, Schenk JP, Wunsch R, Holland-Cunz S, Kessler U, Troger J, et al. Acute testicular torsion in children: the role of sonography in the diagnostic workup. Eur Radiol. 2006;16(11):2527–32.

    Article  PubMed  CAS  Google Scholar 

  • Hadziselimovic F, Geneto R, Emmons LR. Increased apoptosis in the contralateral testes of patients with testicular torsion as a factor for infertility. J Urol. 1998;160(3 Pt 2):1158–60.

    PubMed  CAS  Google Scholar 

  • Hagen P, Buchholz MM, Eigenmann J, Bandhauer K. Testicular dysplasia causing disturbance of spermiogenesis in patients with unilateral torsion of the testis. Urol Int. 1992;49(3):154–7.

    Article  PubMed  CAS  Google Scholar 

  • Hayn MH, Herz DB, Bellinger MF, Schneck FX. Intermittent torsion of the spermatic cord portends an increased risk of acute testicular infarction. J Urol. 2008;180 Suppl 4Suppl 4:1729–32.

    Article  PubMed  Google Scholar 

  • Hegarty PK, Walsh E, Corcoran MO. Exploration of the acute scrotum: a retrospective analysis of 100 consecutive cases. Ir J Med Sci. 2001;170(3):181–2.

    Article  PubMed  CAS  Google Scholar 

  • Jefferson RH, Perez LM, Joseph DB. Critical analysis of the clinical presentation of acute scrotum: a 9-year experience at a single institution. J Urol. 1997;158(3 Pt 2):1198–200.

    PubMed  CAS  Google Scholar 

  • John CM, Kooner G, Mathew DE, Ahmed S, Kenny SE. Neonatal testicular torsion—a lost cause? Acta Paediatr. 2008;97(4):502–4.

    Article  PubMed  Google Scholar 

  • Kadish HA, Bolte RG. A retrospective review of pediatric patients with epididymitis, testicular torsion, and torsion of testicular appendages. Pediatrics. 1998;102(1 Pt 1):73–6.

    Article  PubMed  CAS  Google Scholar 

  • Kalfa N, Veyrac C, Lopez M, Lopez C, Maurel A, Kaselas C, et al. Multicenter assessment of ultrasound of the spermatic cord in children with acute scrotum. J Urol. 2007;177(1):297–301. discussion.

    Article  PubMed  Google Scholar 

  • Karmazyn B, Steinberg R, Kornreich L, Freud E, Grozovski S, Schwarz M, et al. Clinical and sonographic criteria of acute scrotum in children: a retrospective study of 172 boys. Pediatr Radiol. 2005;35(3):302–10.

    Article  PubMed  Google Scholar 

  • Kaye JD, Levitt SB, Friedman SC, Franco I, Gitlin J, Palmer LS. Neonatal torsion: a 14-year experience and proposed algorithm for management. J Urol. 2008a;179(6):2377–83.

    Article  PubMed  Google Scholar 

  • Kaye JD, Shapiro EY, Levitt SB, Friedman SC, Gitlin J, Freyle J, et al. Parenchymal echo texture predicts testicular salvage after torsion: potential impact on the need for emergent exploration. J Urol. 2008b;180 Suppl 4Suppl 4:1733–6.

    Article  PubMed  Google Scholar 

  • Makela E, Lahdes-Vasama T, Rajakorpi H, Wikstrom S. A 19-year review of paediatric patients with acute scrotum. Scand J Surg. 2007;96(1):62–6.

    PubMed  CAS  Google Scholar 

  • Marshall S. Potential problems with testicular prostheses. Urology. 1986;28(5):388–90.

    Article  PubMed  CAS  Google Scholar 

  • Middleton WD, Middleton MA, Dierks M, Keetch D, Dierks S. Sonographic prediction of viability in testicular torsion: preliminary observations. J Ultrasound Med. 1997;16(1):23–7. quiz 9–30.

    PubMed  CAS  Google Scholar 

  • Molokwu CN, Somani BK, Goodman CM. Outcomes of scrotal exploration for acute scrotal pain suspicious of testicular torsion: a consecutive case series of 173 patients. BJU Int. 2011;107(6):990–3.

    Article  PubMed  Google Scholar 

  • Mor Y, Pinthus JH, Nadu A, Raviv G, Golomb J, Winkler H, et al. Testicular fixation following torsion of the spermatic cord—does it guarantee prevention of recurrent torsion events? J Urol. 2006;175(1):171–3. discussion 3–4.

    Article  PubMed  CAS  Google Scholar 

  • Murphy FL, Fletcher L, Pease P. Early scrotal exploration in all cases is the investigation and intervention of choice in the acute paediatric scrotum. Pediatr Surg Int. 2006;22(5):413–6.

    Article  PubMed  Google Scholar 

  • Nandi B, Murphy FL. Neonatal testicular torsion: a systematic literature review. Pediatr Surg Int. 2011; 27(10):1037–40.

    Article  PubMed  Google Scholar 

  • Pinto KJ, Noe HN, Jerkins GR. Management of neonatal testicular torsion. J Urol. 1997;158(3 Pt 2):1196–7.

    PubMed  CAS  Google Scholar 

  • Puri P, Barton D, O’Donnell B. Prepubertal testicular torsion: subsequent fertility. J Pediatr Surg. 1985;20(6):598–601.

    Article  PubMed  CAS  Google Scholar 

  • Sells H, Moretti KL, Burfield GD. Recurrent torsion after previous testicular fixation. ANZ J Surg. 2002; 72(1):46–8.

    Article  PubMed  Google Scholar 

  • Sessions AE, Rabinowitz R, Hulbert WC, Goldstein MM, Mevorach RA. Testicular torsion: direction, degree, duration and disinformation. J Urol. 2003;169(2):663–5.

    Article  PubMed  Google Scholar 

  • Soccorso G, Ninan GK, Rajimwale A, Nour S. Acute scrotum: is scrotal exploration the best management? Eur J Pediatr Surg. 2010;20(5):312–5.

    Article  PubMed  CAS  Google Scholar 

  • Srinivasan A, Cinman N, Feber KM, Gitlin J, Palmer LS. History and physical examination findings predictive of testicular torsion: an attempt to promote clinical diagnosis by house staff. J Pediatr Urol. 2011;7(4):470–4.

    Article  PubMed  Google Scholar 

  • Waldert M, Klatte T, Schmidbauer J, Remzi M, Lackner J, Marberger M. Color Doppler sonography reliably identifies testicular torsion in boys. Urology. 2010;75(5):1170–4.

    Article  PubMed  Google Scholar 

  • Yerkes EB, Robertson FM, Gitlin J, Kaefer M, Cain MP, Rink RC. Management of perinatal torsion: today, tomorrow or never? J Urol. 2005;174(4 Pt 2):1579–82. discussion 82–3.

    Article  PubMed  Google Scholar 

  • Zinn HL, Cohen HL, Horowitz M. Testicular torsion in neonates: importance of power Doppler imaging. J Ultrasound Med. 1998;17(6):385–8.

    PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Pediatric Urology, University of Texas Southwestern Medical Center and Children’s Medical Center Dallas, 1935 Medical District Drive, MS F4.04, Dallas, TX, 75235, USA

    Warren T. Snodgrass M.D., Linda A. Baker M.D. & Nicol C. Bush M.D., M.S.C.S.

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  1. Warren T. Snodgrass M.D.
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  2. Linda A. Baker M.D.
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  3. Nicol C. Bush M.D., M.S.C.S.
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Correspondence to Warren T. Snodgrass M.D. .

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Editors and Affiliations

  1. Children’s Medical Center Dallas, Department of Pediatric Urology, University of Texas Southwestern Medical, N/A, Dallas, 75235, Texas, USA

    Warren T. Snodgrass

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Snodgrass, W.T., Baker, L.A., Bush, N.C. (2013). Testicular Torsion. In: Snodgrass, W. (eds) Pediatric Urology. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-6910-0_7

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  • DOI: https://doi.org/10.1007/978-1-4614-6910-0_7

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