Testicular torsion

Testicular torsion is a urologic emergency.

A high index of suspicion is important to ensure timely diagnosis and management.

Increased public awareness is important in reducing embarrassment and increasing the number of patients presenting within 6 hours of symptom onset.

A history and physical exam consistent with testicular torsion mandates an immediate surgical consult for scrotal exploration, without delay for additional diagnostic tests.

Usually affects young males but may affect males of any age.

Testicular torsion is a urologic emergency caused by the twisting of the testicle on the spermatic cord leading to constriction of the vascular supply, time-sensitive ischemia, and/or necrosis of testicular tissue.[1]Laher A, Ragavan S, Mehta P, et al. Testicular torsion in the emergency room: A review of detection and management strategies. Open Access Emerg Med. 2020;12:237-246. https://www.doi.org/10.2147/OAEM.S236767 http://www.ncbi.nlm.nih.gov/pubmed/33116959?tool=bestpractice.com

Anatomically, there are three types of testicular torsion: intravaginal torsion, extravaginal torsion, and torsion due to a long mesorchium.

Intravaginal torsion is the most common type and occurs when the spermatic cord twists within the tunica vaginalis, usually as a result of the bell clapper deformity.[2]Gupta A, Croake A, Rubens D, et al. Do not get it twisted: common and uncommon manifestations of testicular torsion. J Ultrasound Med. 2022 Feb;41(2):271-83. http://www.ncbi.nlm.nih.gov/pubmed/33885184?tool=bestpractice.com [3]Lacy A, Smith A, Koyfman A, et al. High risk and low prevalence diseases: testicular torsion. Am J Emerg Med. 2023 Apr;66:98-104. http://www.ncbi.nlm.nih.gov/pubmed/36738571?tool=bestpractice.com ​​​​ Extravaginal torsion occurs when the spermatic cord twists outside of the tunica vaginalis during the perinatal period.[2]Gupta A, Croake A, Rubens D, et al. Do not get it twisted: common and uncommon manifestations of testicular torsion. J Ultrasound Med. 2022 Feb;41(2):271-83. http://www.ncbi.nlm.nih.gov/pubmed/33885184?tool=bestpractice.com A long mesorchium can also twist and lead to torsion.[2]Gupta A, Croake A, Rubens D, et al. Do not get it twisted: common and uncommon manifestations of testicular torsion. J Ultrasound Med. 2022 Feb;41(2):271-83. http://www.ncbi.nlm.nih.gov/pubmed/33885184?tool=bestpractice.com [4]Chan JL, Knoll JM, Depowski PL, et al. Mesorchial testicular torsion: case report and a review of the literature. Urology. 2009 Jan;73(1):83-6. http://www.ncbi.nlm.nih.gov/pubmed/18774594?tool=bestpractice.com