testicular torsion

Testicular Torsion 

Definition

Testicular torsion is the twisting of a testis (testicle) on its connection.

Description

The testes are suspended in the scrotum by a single bundle of tissues that also carries the blood supply to and from the testes. If the testicle rotates, the bundle kinks, and the blood supply is shut off. The resulting situation is an emergency because the testis will die within hours if the blood supply is not restored.

Causes and symptoms

Some testes hang in such a way that they twist more easily than others. Nearly all torsions happen to adolescent males—between the ages of 12 and 18—because their testes enlarge by a factor of five to six during puberty. A larger testis is more likely to twist. Torsion can also occur in a newborn.

Symptoms of testicular torsion are sudden severe pain in the scrotum, swelling, nausea and vomiting.

A rare condition, testicular torsion occurs when the spermatic cord is twisted and cuts off the blood supply to the testicle.

(Illustration by Argosy Inc.)

Diagnosis

A nuclear scan of the scrotum may be performed. In this procedure, a tiny amount of radioactive fluid is injected into the blood and detected as it flows through the scrotum and testicles. Torsion is indicated if the radioactive fluid does not flow through the sore testis. Ultrasound scan accompanied by a contrast agent can also be used to diagnose testicular torsion.

Treatment

Surgery must be performed within 24 hours to ensure the health of the affected testis. During the procedure, the surgeon untwists the cord and secures the testis in place so that it cannot rotate again. The other testicle should also be secured to deter future testicular torsion. This procedure is called orchiopexy.

Prognosis

If the torsion is relieved within 24 hours, the testis will recover normal blood flow and function.

Prevention

Torsion of the unaffected testis is prevented by securing it during the surgery to correct the twisted testis.

Resources

Books

Walsh, Patrick C., et al., editors. Campbell's Urology. Philadelphia: W. B. Saunders Co., 1998.

Key terms

Orchiopexy — The surgical securing of the testis to prevent torsion.

Scrotum — The bag of skin below the penis that contains the testes.

---

testicular

pertaining to the testis.

---

testicular agenesis

absence of one or both testes, usually part of a wider range of defects.

testicular anomaly

includes hypoplasia, cryptorchidism, agenesis, heterotopia, polyorchidism, cystic rete testis and heterotopic Leydig cells and accessory adrenal cortical tissue.

testicular biopsy

percutaneous sampling of tissue for laboratory examination; disruption of normal spermatogenesis can be expected.

testicular calcinosis

common as a sequel to chronic inflammation and concurrent with fibrosis.

testicular degeneration

the most frequent cause of male infertility; many causes; regeneration and return to normal function possible provided some spermatogonia survive the insult and the basement membrane of the tubules is undamaged.

testicular descent

includes a long-distance, passive descent from the roof of the abdomen to near the inguinal canal followed by a short-distance, also passive, descent through the inguinal canal into the scrotum.

testicular feminization syndrome

an extreme form of male pseudohermaphroditism, with female external development, including secondary sex characteristics, but with the presence of testes and absence of uterus and tubes; it is due to end-organ resistance to the action of testosterone.

testicular fibrosis

a sequel to inflammation or degeneration; common in old bulls.

testicular foreign body constriction

malicious application of a constricting foreign body, usually an elastic band, around the base of the scrotum in dogs is an occasional cause of orchitis and often necessitates castration with scrotal ablation. Called also the 'nasty child syndrome', although 'bull terrier bite' would probably be more common.

testicular hypoplasia

occurs as an uncomplicated state, or as part of cryptorchidism or intersex anomaly; an inherited defect in Swedish Highland cattle.

testicular inflammation

see orchitis.

testicular lobuli

lobules created in the testis by connective tissue septa.

testicular mediastinum

the central dividing plane of tissue which divides the testis and is continuous with its tunica albuginea.

testicular septuli

loose connective tissue septa which divide testis into lobules.

testicular torsion

causes pain and swelling of the scrotum, abdominal pain and vomiting. In dogs, testicles with neoplasms are predisposed to torsion. Occurs occasionally in stallions (180° torsion), with no apparent detrimental consequences on health or fertility.

testicular tumors

includes interstitial cell and Sertoli cell tumors and seminomas.

---

testicular torsion

Torsion of testes Urology Twisting of the spermatic cord, with ↓ blood supply to the testes and scrotum; it is the most common cause of scrotal pain in boys, most of whom are < age 6, ±linked to ↓ connective tissue in the scrotum, trauma, or physical activity