Testicular Torsion

Definition
• Testicular torsion is an emergency in the form of rotation of the
longitudinal axis of the spermatic cord which results in blocked
testicular blood flow.
• Most acute cases of scrotum in children are testicular torsion,
therefore a boy with acute scrotal pain must be assumed to have a
spermatic cord torsion until not proven.
Epidemiology
• Testicular torsion is the most common cause of acute scrotum.
• The incidence of testicular torsion is 1 in 4000 men before the
age of 25 years.
• Testicular torsion can occur at any age, most often at the age of
12-16 years; the left side is more frequent. The median age of
testicular torsion patients is 15 years
Risk Factors
• Season with lower and humid temperatures such as spring and
cold are associated with a high incidence of torsion.
• Pregnancy with complications such as prolonged labor,
preeclampsia, diabetes gestational, twin pregnancy, weight gain
large birth, and vaginal delivery are the predisposing factors for
torsion testis in neonates.
• Studies also show a relationship family history.
• Cryptorchidism or undescended testicles are also said to
increase 10 times the risk of testicular torsion
Classification
• Testicular torsion according to the cause is divided to be
extravaginal and intravaginal.
• Type extravaginal more often found in perinatal age, whereas
intravaginal type which accounts for 90% of the cases of
teticular torsion, the most often in children and adolescents.
Classification
• Testicular torsion is also divided according to its duration since
onset. The distribution is clarified also with pathological features on
sonography examination
• Type 1 - acute phase; testicular torsion is marked by enlarging the
size of the testes and heterogeneous on ecogenicity, liquid subtunika
and Doppler flow do not detected.
• Type 2 - Initial phase; parenchymal atrophy progressive
characterized by testicular size normal and symmetrical with the
testes healthy, hypoecogenic and small hydrocele.
• Type 3 - Late phase; parenchymal atrophy progressive marked with
decline testicular size, increased ecogenicity testicles and without
hydrocele.
Pathophysiology
1. Intravaginal
• The cause of intravaginal torsion type is anatomical abnormalities in the form of
tunica vaginalis which covers the entire testis and epididymis so that the
attachment to the scrotum is disrupted.
• This deformity is better known as "bell clapper "which is marked by an increase
testicular mobility.
• Intravaginal torsion testicles most often occurs during sleep, and effects trauma.
2. Extravaginal
• The extravaginal testicular torsion is most often on torsio fetal and neonatal
cases.
• On torsion of this type, spermatic cord twisting occurs in outside of the tunica
vaginalis sac in the scrotum.
• The external spermatic fascia is not attached dartos muscle, and newly formed
attachment of the spermatic cord to the scrotum on 7-10 days of life
Diagnosis
• History Taking
The pathognomonic symptoms are unilateral great pain sudden at rest
and often accompanied by nausea, vomiting. Nausea, vomiting
caused by reflex stimulation celiac ganglion.
• Physical Examination
tenderness, abnormal testicular position, and loss of cremaster
reflexes. Phren mark examination is carried out with lift the testicles, if
the pain does not go away indicates the state of torsion.
• Radiology
Doppler ultrasound (DUS) and Radionuclide Scrotal Imaging (RNSI)
Treatment
• Manual detorsion
• Surgical Exploration
Prognosis
• Infertility
• The sooner the diagnosis is established, <6 hours, the
prognosis will be better.
Daftar Pustaka
• Molokwu CN, Somani BK, Goodman CM. Outcomes of scrotal
exploration for acute scrotal pain suspicious of testicular torsion: A
consecutive case series of 17 patientss. BJUI. 2010;107:990-3.
• Bayne AP, Fuentes RJM, Jones EA, Cisek LJ, Gonzales ET, Reavis KM,
Roth DR, et al. Factor associated with delayed treatmet of acute
testicular torsion-do demographics or interhospital transfer matter?. J
Urol. 2010;184:1743-7.
• Mellick LB. Torsion of the testicle. Pediatr Emerg Care. 2012;28:80-6.