The age distribution of testicular torsion is bimodal, with one peak in the neonatal period and the second peak around puberty. Intermittent testicular torsion in the pediatric patient resolution. In determining the proper intervention, it is essential to document the appearance of the scrotum and testes at birth. This condition is a true urologic emergency and must be differentiated from other etiologies of testicular pain because a delay in diagnosis and management can lead to loss of the testicle. Torsion of the testes is a rare event in the neonatal period, but there is controversy as to its optimal management. Physicians should pay close attention to the specific.
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. Presentation and management of testicular complaints can vary. While both conditions can cause testicular pain, the pain of epididymitis is typically localized to the epididymis at the rear pole of the testicle. 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. When this occurs, blood supply is cut off to the testicles and nearby tissue in the scrotum. Feb 21, 2018 testicular grayscale ultrasound is the modality of choice for the imaging evaluation of acute scrotal pain. 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. A patient is described with trauma induced testicular torsion who presented on three occasions before a decision was.
Testicular torsion right n 43, left n 60, bilateral n 1 was identified in 104 boys between 0 and 18 years. Cureus emergency department approach to testicular torsion. Individuals involved in sports are at risk for sustaining various injuries. Testicular torsion occurs when a testicle torts on the spermatic cord resulting in the cutting off of blood supply. Pdf on sep 1, 2012, jiahwia wang and others published testicular torsion find, read and cite all the research you need on researchgate. Testicular torsion is most common between ages 12 and 16, but it can occur at any age, even before birth. Testicular torsion right n 43, left n 60, bilateral n 1 was identified in 104 boys between 0 and 18. The signs and symptoms of testicular torsion may easily be mistakenly attributed to preceeding testicular trauma if there was such an event. In the setting of acute testicular torsion, immediate urologic consultation for operative repair is essential to optimize testicular salvageability. Testicular torsion is one of the few emergencies in pediatric urology which requires an accurate and timely diagnosis in order to avoid testis loss.
The most important point in arriving at a management decision is a determination of what the scrotum looked like at birth. With mature attachments, the tunica vaginalis is attached securely to the. Spermatic cord torsion testicular torsion intermittent. Clinical and sonographic features predict testicular torsion in children. The impact of testicular torsion on testicular function. Role of spectral doppler sonography in the evaluation of partial testicular torsion. The patient should be kept fasted and a surgical referral should be made without delay. Testicular torsion occurs when the spermatic cord becomes twisted. Consider the diagnosis of testicular torsion in all patients with acute testicular pain. 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. During testicular torsion a testicle rotates, twisting the spermatic cord that brings blood to the scrotum, the loose bag of skin under the penis that contains the testicles. The finding of an ipsilateral absent cremasteric reflex is the most accurate sign of testicular.
He was initially diagnosed with epididymitis based on the presence of an enlarged supratesticular mass seen. Herein, we describe a case report involving testicular torsion in a rarely seen age group. Testicular torsion as seen in university of maiduguri. Classically, testicular torsion presents with sudden onset, severe scrotal pain with associated swelling, nausea and vomiting. The presence of intratesticular flow does not exclude testicular torsion. In the last 5 years, 46 patients 2362, average age 43. The condition is treated as an emergency because the preservation of the testicle and ultimately fertility is dependent on early diagnosis and treatment. Uss and bloods are not routinely required may delay diagnosis and. The most common symptom is acute testicular pain and the most common underlying cause, a bellclapper deformity. Testicular torsion in the perinatal period is an uncommon finding. Testicular torsion is a surgical emergency testis viability can diminish considerably six hours after symptom onset.
Testis tissue survival after tt is dependent on the degree and duration of tt. Ten newborns presented with 11 intrauterine torsions. Testicular torsion children abdominal pain acute scrotum. Partial testicular torsion and torsiondetorsion syndrome. Do not forget to include testicular torsion in differential diagnosis of.
This condition is a true urologic emergency and must be differentiated from other etiologies of testicular pain because a delay in diagnosis and management can lead to loss of the testicle 8. When this happens there is a loss of blood supply to the ipsilateral testicle 1. Testicular torsion occurs when the testicle twists around the spermatic cord, resulting in blood flow to the testicle being compromised. We performed a prospective study of all boys treated for.
This reflex is elicited by stroking or pinching the medial thigh, causing. The most sensitive physical finding in testicular torsion is the absence of the cremasteric reflex. Testicular torsion is caused by twisting of the spermatic cord and the blood supply to the testicle see the image below. An experience at a tertiary care centre saleh o, elsharkawi ms, imran mb abstract introduction.
Accurate diagnosis of testicular torsion is important to avoid serious consequences of any delay in proper management. Neonatal testicular torsion, also known as perinatal testicular torsion is a subject of debate among surgeons. In 91% to 95% of appendiceal torsions, the appendix testis is involved and this is most commonly seen in boys between 7 and 14 years of age 7. However, it can result in vascular compromise leading to testicular ischemia and injury, and if not corrected, necrosis and testicular nonviability. Testicular torsion was the most common cause of impaired intratesticular blood flow 119 cases, 50. You and the patient cant afford to miss torsion but ultrasound can be falsely negative in a patient who is torsing and detorsing.
If youve had testicular pain that went away without treatment intermittent torsion and detorsion, its likely to occur again. Testicular torsion accounts for up to 26% of cases of acute scrotum and is the most important diagnosis to rule out because it is a surgical emergency. Torsion of the testes is a rare event in the neonatal period, and its management remains controversial. Testicular torsion is defined as the torsion of the spermatic cord structures. Sep 30, 2012 testicular torsion occurs when a testicle rotates, twisting the spermatic cord that brings blood to the scrotum. Perinatal testicular torsion intrauterine and postnatal in the first 30 days is an uncommon entity and represents about 12% of all testicular torsions during infancy28. These issues can range from an acute emergency such as testicular torsion to indolent testicular tumors. Testicular torsion is a common pediatric urologic emergency that affects 3. 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. If there is any suspicion of testicular torsion, a prompt referral to a surgeon with relevant experience or to the emergency department. Neonatal testicular torsion either intrauterine or postnatal results into. Each year, testicular torsion affects one in 4,000 males younger than 25 years. Torsion of the testicular appendages in adult acute scrotum. Prompt diagnosis remains difficult and testicular salvage rates depends on the interval between symptom onset and the surgical treatment.
The acute scrotum in childhood and adolescence ncbi. The aim of surgery is assessment of testicular viability, manual detorsion of the testicle and scrotal orchidopexy to prevent recurrence of the torsion in the future. Torsion of the testis, also referred to as torsion of the spermatic cord, is a subject of debate among physicians and surgeons. Aug 31, 2018 testicular torsion refers to the torsion of the spermatic cord structures and subsequent loss of the blood supply to the ipsilateral testicle. History, physical examination and ultrasound are all flawed in making the diagnosis. Torsion of the testicle it is time to stop tossing the dice larry b. Testicular torsion treatment algorithm bmj best practice. It is thought that the majority 70% of perinatal torsions are present at delivery and 30% develop postnatally in the first month of life29. Testicular torsion is a surgical emergency that requires immediate urologic consultation to increase the rate of tissue salvage. Testicular torsion american pediatric surgical association. 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. Testicular torsion symptoms, diagnosis and treatment. 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.
Pdf torsion of the testicle it is time to stop tossing the dice. An update on the diagnosis and management of ovarian torsion. 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 is a true surgical emergency requiring early surgical intervention for successful salvage.
In fact, testicular torsion is more common than testicular tumors for this same age group, yet testicular torsion has not been given the public attention it deserves as a male health risk. The decision for orchiectomy versus orchidopexy is based on the extent of damage to testicular tissue. Testicular torsion as seen in university of maiduguri teaching. Acute abdominal pain can be the initial and sole symptom of testicular torsion in young males. The reduced blood flow causes sudden and often severe pain and swelling. However a curious finding is the presence of hydrocele, while varicocele, hernia, patent. Testicular vascularity can look symmetrical with the contralateral asymptomatic side with preserved arterial and venous flow and still represent testicular torsion. The surgical approach to this condition has developed over the. Lambert, in averys diseases of the newborn ninth edition, 2012. We believe that it should carry out a surgical exploration as quick as possible because if any. Because of venous congestion, the affected testis also may appear larger than the unaffected testis.
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. Where there is a suspicion of testicular tumour preceding mass or chronic history 24. Testicular torsion occurs when the spermatic cord from which the testicle is suspended twists, cutting off the blood supply to the testicle. Testicular torsion is an urgent urological condition requiring prompt surgical intervention. Testicular torsion is an emergency and requires rapid urological referral the patient almost always presents with pain of less than 24 hours duration differential diagnosis includes torsion of testicular appendages and epididymitis dipstix urinalysis is the only mandatory investigation and is. Testicular torsion is most common between ages 12 and 18. Torsion of the testicle mcmaster faculty of health sciences. Testicular torsion testicular torsion is the twisting of the spermatic cord causing severe pain and ischemia of the testicle. Factors associated with delayed treatment of acute testicular torsion do demographics or interhospital transfer matter.
Early diagnosis and definitive management are the keys to avoid testicular loss. Testicular torsion is a twisting of the spermatic cord and its contents and is a surgical emergency affecting 3. It is not an uncommon event affecting a young male population. Its management is controversial, due to the low viability of the testis and the possibility of bilateral torsion. Intermittent testicular torsion in the pediatric patient. Testis viability is very low, however there are cases that after an early diagnosis and detorsion, orchiectomy was not necessary. Zderic, in averys diseases of the newborn eighth edition, 2005. Most are extravaginal, and intravaginal torsion is rare. Torsion of the spermatic cord in childhood and adolescence trepo. Testicular torsion testickyooler torshun happens when the testicle gets twisted within the scrotum. Combining bmode and power doppler imaging facilitates a. Ultrasonography is the method of choice to study testicular torsion.
The decision for orchiectomy is made intraoperatively, usually by testicle color and lack of blood flow. Ultrasonography is helpful to rule out testicular torsion. Trauma induced testicular torsion is a well recognised entity, the incidence being 48% in most studies reporting on testicular torsion. Acute scrotal pain emergency management in children.
The most common symptom in children is sudden, severe testicular pain. Neonatal testicular torsion, defined as torsion occurring within the first 30 days of life, is a rare occurrence. Testicular torsion symptoms and causes mayo clinic. In this report, i investigate the incidence of patients with torsion of the testicular appendages among patients with adult acute scrotum, who mainly used to be treated for epididymitis. If you continue browsing the site, you agree to the use of cookies on this website. Testicular torsion is a urological emergency caused by the twisting of the testicle on the spermatic cord leading to constriction of the vascular supply and timesensitive ischaemia andor necrosis of testicular tissue. It is important to highlight that a testicular torsion is the most important differential diagnosis and the main priority in each case is to diagnosis. Torsion of the testicular appendix is the most common cause of acute scrotum in children. It causes occlusion of testicular blood vessels and, unless prompt action is taken, rapidly leads to ischaemia, resulting in loss of the testis germ cells are the most susceptible cell line to ischaemia. Volume 11 number 1, june 2012 imjm scrotal scintigraphy in testicular torsion. A presumptive diagnosis of testicular torsion should be made promptly on history and examination alone. Given the treatment implications of testicular torsion, it is important to distinguish testicular torsion from other causes of testicular pain, such as epididymitis, which can present similarly. Treatment manual detorsion controversial open the book or external rotation technique but 25% torse opposite direction not a substitute for surgical intervention still need orchiopexy may provide earlier relief of symptoms and increase the rate of testis salvage 9 testicular torsion. 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.
Testicular torsion is the twisting of the spermatic cord causing severe pain and ischemia of the testicle. The more frequent the bouts of pain, the higher the risk of testicular damage. All prepubertal and young adult males with acute scrotal pain should be considered to have testicular torsion until proven otherwise. Diagnosis and management of testicular torsion, torsion of. Historical, clinical, and sonographic findings should all be used in making the diagnosis. Testicular awareness is an allencompassing concept since it helps men become familiar with a body part that is seldom discussed and enables them to detect testicular abnormalities and to seek timely medical attentions for testicular symptoms, regardless of the ultimate diagnosis.
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