| Testicular torsion | |
|---|---|
 | |
| 1. Epididymis 2. Head of epididymis 3. Lobules of epididymis 4. Body of epididymis 5. Tail of epididymis 6. Duct of epididymis 7. Deferent duct (ductus deferens or vas deferens) | |
| Specialty | Urology |
| Symptoms | Severe testicular pain, elevated testicle[1] |
| Complications | Infertility[2] |
| Usual onset | Sudden[1] |
| Types | Intravaginal torsion, extravaginal torsion[1] |
| Risk factors | "Bell clapper deformity", testicular tumor, cold temperature[1] |
| Diagnostic method | Based on symptoms[1] |
| Differential diagnosis | Epididymitis, inguinal hernia, torsion of the appendix testicle[2] |
| Treatment | Physically untwisting the testicle, surgery[1] |
| Prognosis | Generally good with rapid treatment[1] |
| Frequency | ~1 in 15,000 per year (under 25 years old)[2][3] |
Testicular torsion occurs when the spermatic cord (from which the testicle is suspended) twists, cutting off the blood supply to the testicle.[3] The most common symptom in children is sudden, severe testicular pain.[1] The testicle may be higher than usual in the scrotum and vomiting may occur.[1][2] In newborns, pain is often absent and instead the scrotum may become discolored or the testicle may disappear from its usual place.[1]
Most of those affected have no obvious prior underlying health problems.[1] Testicular tumor or prior trauma may increase risk.[1][3] Other risk factors include a congenital malformation known as a "bell-clapper deformity" wherein the testis is inadequately attached to the scrotum allowing it to move more freely and thus potentially twist.[1] Cold temperatures may also be a risk factor.[1] The diagnosis should usually be made based on the presenting symptoms, but requires timely diagnosis and treatment to avoid testicular loss.[4][page needed][1][2] An ultrasound can be useful when the diagnosis is unclear.[2]
Treatment is by physically untwisting the testicle, if possible, followed by surgery.[1] Pain can be treated with opioids.[1] Outcome depends on time to correction.[1] If successfully treated within six hours onset, it is often good. However, if delayed for 12 or more hours the testicle is typically not salvageable.[1] About 40% of people require removal of the testicle.[2]
It is most common just after birth and during puberty.[2] It occurs in about 1 in 4,000 to 1 in 25,000 males under 25 years of age each year.[2][3] Of children with testicular pain of rapid onset, testicular torsion is the cause of about 10% of cases.[2] Complications may include an inability to have children.[2] The condition was first described in 1840 by Louis Delasiauve.[5]
- ^ a b c d e f g h i j k l m n o p q r s Ludvigson, AE; Beaule, LT (June 2016). "Urologic Emergencies". The Surgical Clinics of North America. 96 (3): 407–24. doi:10.1016/j.suc.2016.02.001. PMID 27261785.
- ^ a b c d e f g h i j k Sharp, VJ; Kieran, K; Arlen, AM (Dec 15, 2013). "Testicular torsion: diagnosis, evaluation, and management". American Family Physician. 88 (12): 835–40. PMID 24364548. Archived from the original on 2016-11-04.
- ^ a b c d Wampler SM, Llanes M (September 2010). "Common scrotal and testicular problems". Prim. Care. 37 (3): 613–26, x. doi:10.1016/j.pop.2010.04.009. PMID 20705202.
- ^ Gomella, Leonard G., ed. (2015) [2000]. The 5-minute urology consult (3rd ed.). Philadelphia, PA: Wolters Kluwer Health. ISBN 978-1-4511-8998-8. LCCN 2014037959.
- ^ Schill, Wolf-Bernhard; Comhaire, Frank H.; Hargreave, Timothy B. (2006). Andrology for the Clinician. Springer Science & Business Media. p. 134. ISBN 9783540337133. Archived from the original on 2017-09-10.