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dilznik
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I did a little research.
Background: Testicular torsion is a urologic emergency and must be differentiated from other complaints of testicular pain because a delay in diagnosis can lead to loss of the testicle. In adolescent males, testicular torsion is the most frequent cause of testicle loss.
Pathophysiology: The typical testicle is covered by the tunica vaginalis, which attaches to the posterolateral surface of the testicle and allows for little mobility.
In patients who have an inappropriately high attachment of the tunica vaginalis (ie, bell clapper deformity), the testicle can rotate freely on the spermatic cord within the tunica vaginalis (intravaginal testicular torsion). This congenital anomaly is present in approximately 12% of males, 40% of which have the abnormality in the contralateral testicle as well. The bell clapper deformity allows the testicle to twist spontaneously on the spermatic cord, causing venous occlusion and engorgement, with subsequent arterial ischemia causing infarction of the testicle. Experimental evidence indicates that 720° torsion is required to compromise flow through the testicular artery and result in ischemia.
In the neonatal age group, the testicle frequently has not yet descended into the scrotum and becomes attached within the tunica vaginalis. Additionally, this mobility of the testicle predisposes it to torsion (extravaginal testicular torsion).
Frequency:
In the US: Incidence of torsion in males younger than 25 years is approximately 1 in 4000. Torsion more often involves the left testicle.
Mortality/Morbidity: This urologic emergency requires prompt diagnosis, immediate urologic referral, and rapid definitive treatment for salvage of the testicle.
A salvage rate of 80-100% is found in patients who present within 6 hours of pain.
After 6-8 hours, the salvage rate markedly decreases, and it is near 0% at 12 hours.
Sex: Testicular torsion affects males only.
Age: Testicular torsion most often is observed in males younger than 30 years, with most aged 12-18 years. The peak age is 14 years, although a smaller peak also occurs during the first year of life.
History:
History includes a sudden onset of severe unilateral scrotal pain.
As many as 50% of patients have a history of prior episodes of intermittent testicular pain that has resolved spontaneously (intermittent torsion and detorsion).
Onset of pain can occur more slowly, but this is an uncommon presentation of torsion.
Torsion can occur with activity, be related to trauma, or develop during sleep and includes the following:
Scrotal swelling
Nausea and vomiting (20-30%)
Abdominal pain (20-30%)
Fever (16%)
Urinary frequency (4%)
Physical:
Involved testicle painful to palpation; frequently elevated in position when compared to the other side
Horizontal lie of the testicle
Enlargement and edema of the testicle; edema involving the entire scrotum
Scrotal erythema
Ipsilateral loss of the cremasteric reflex
Usually, no relief of pain upon elevation of scrotum (elevation may improve the pain in epididymitis [Prehn sign])
Fever (uncommon)
Causes:
Congenital anomaly; bell clapper deformity
Undescended testicle
Sexual arousal and/or activity
Trauma
Exercise
Active cremasteric reflex
Cold weather
Background: Testicular torsion is a urologic emergency and must be differentiated from other complaints of testicular pain because a delay in diagnosis can lead to loss of the testicle. In adolescent males, testicular torsion is the most frequent cause of testicle loss.
Pathophysiology: The typical testicle is covered by the tunica vaginalis, which attaches to the posterolateral surface of the testicle and allows for little mobility.
In patients who have an inappropriately high attachment of the tunica vaginalis (ie, bell clapper deformity), the testicle can rotate freely on the spermatic cord within the tunica vaginalis (intravaginal testicular torsion). This congenital anomaly is present in approximately 12% of males, 40% of which have the abnormality in the contralateral testicle as well. The bell clapper deformity allows the testicle to twist spontaneously on the spermatic cord, causing venous occlusion and engorgement, with subsequent arterial ischemia causing infarction of the testicle. Experimental evidence indicates that 720° torsion is required to compromise flow through the testicular artery and result in ischemia.
In the neonatal age group, the testicle frequently has not yet descended into the scrotum and becomes attached within the tunica vaginalis. Additionally, this mobility of the testicle predisposes it to torsion (extravaginal testicular torsion).
Frequency:
In the US: Incidence of torsion in males younger than 25 years is approximately 1 in 4000. Torsion more often involves the left testicle.
Mortality/Morbidity: This urologic emergency requires prompt diagnosis, immediate urologic referral, and rapid definitive treatment for salvage of the testicle.
A salvage rate of 80-100% is found in patients who present within 6 hours of pain.
After 6-8 hours, the salvage rate markedly decreases, and it is near 0% at 12 hours.
Sex: Testicular torsion affects males only.
Age: Testicular torsion most often is observed in males younger than 30 years, with most aged 12-18 years. The peak age is 14 years, although a smaller peak also occurs during the first year of life.
History:
History includes a sudden onset of severe unilateral scrotal pain.
As many as 50% of patients have a history of prior episodes of intermittent testicular pain that has resolved spontaneously (intermittent torsion and detorsion).
Onset of pain can occur more slowly, but this is an uncommon presentation of torsion.
Torsion can occur with activity, be related to trauma, or develop during sleep and includes the following:
Scrotal swelling
Nausea and vomiting (20-30%)
Abdominal pain (20-30%)
Fever (16%)
Urinary frequency (4%)
Physical:
Involved testicle painful to palpation; frequently elevated in position when compared to the other side
Horizontal lie of the testicle
Enlargement and edema of the testicle; edema involving the entire scrotum
Scrotal erythema
Ipsilateral loss of the cremasteric reflex
Usually, no relief of pain upon elevation of scrotum (elevation may improve the pain in epididymitis [Prehn sign])
Fever (uncommon)
Causes:
Congenital anomaly; bell clapper deformity
Undescended testicle
Sexual arousal and/or activity
Trauma
Exercise
Active cremasteric reflex
Cold weather
