Testicular

torsion
Darul Ilham
• Testicular torsion is a twisting of the spermatic cord and it
is a surgical emergency.
• Testicular torsion is one of the common causes of acute
scrotum in adolescents.
• leading to decreased blood flow to the testicle resulting in
ischemia, infarction and tissue necrosis.
anatomy
 incidence
• incidence of 3.8 per 100,000 males younger than 18
years. Historically, the annual incidence has been closer to
one per 4,000.It accounts for approximately 10% to 15%
of acute scrotal disease in children, and results in an
orchiectomy rate of 42% in boys undergoing surgery for
testicular torsion.
 Type of testicular torsion
1. Intravaginal torsion
Is the more common type, occurring most frequently at
puberty.
2. Extravaginal torsion Most often occurs in newborns.
 Symptoms of testicular torsion
• a sudden onset of pain
• nausea
• and may vomit
• Physical examination may demonstrate a swollen,
asymmetric scrotum with a tender, The testis seems high.
• Reflex cremaster absent
• erythematous, and warm
 Pathophysiology
Testicle rotates on spermatic cord

Venous occlusion, edema

Arterial ischemia

Infarction.
 Differential diagnosis
• Hydrocele
• Epididymitis
• Testicular tumor
• scrotal abscess
 imagine
• The modality is Doppler ultrasonography which is a
highly sensitive (88.9%) and specific (98.8%) preoperative
diagnostic tool with a 1% false-negative rate. Doppler
ultrasonography evaluates the size, shape, echogenicity,
and perfusion of both testicles.
• Colour Doppler should reveal bilaterally symmetric and
relatively uniform flow through both testes and epididymides.
• Color Doppler ultrasonogram showing late torsion affecting the
right testis in a 16-year-old boy who had pain for 24 hours. Note
increased blood flow around the right testis but absence of flow
within the substance of the testis
 Treatment
• Manual detorsion: medial to lateral; “opening a book” –
May need to rotate 2-3 times for complete detorsion.
• Definitive treatment: surgical detorsion and orchioplexy
Thanks You
•  Norman S, Christoper J, Bailey & Love's Short Practice of
Surgery, 25th edn London, 2008 
• Victoria J. Kathleen K. Testicular Torsion: Diagnosis,
Evaluation, and Management. American Family Physycian.
 2013:88(12):835-840.
• Romeo C, Impellizzeri P, Arrigo T, et al. Late hormonal
function after testicular torsion. J Pediatr Surg.
2010;45(2):411–413