Materiały źródłowe

• #1 Testicular Torsion: Practice Essentials, Background, Anatomy

  https://emedicine.medscape.com/article/2036003-overview

  Extravaginal testicular torsion typically affects newborn boys, with an incidence of 1 in 7500. It constitutes 12% of all testicular torsions. Most of the torsions in this group (72%) occur prior to delivery. Postnatal torsion (normal testis at birth) within 30 days of birth comprises 28% of this cohort. It is typically unilateral and affects left and right testes equally, but bilateral torsion has been noted in 1121% of newborns and is synchronous in 80%. […] The annual incidence of intravaginal testicular torsion has been noted to be 4.5 per 100,000 males. Approximately 86% of cases occur in males older than 10 years (median age, 15 years). However, torsion has been reported in men up to the age of 78 years. […] During the COVID-19 pandemic, delayed healthcare-seeking behaviors significantly impacted the presentation of testicular torsion cases. Fear of exposure to the virus and restricted access to medical facilities led to longer symptom durations before hospital visits.

• #2 Testicular Torsion – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK448199/

  The majority of cases occur in the adolescent age range (during periods of growth) but can occur at any age as well as pre- or perinatal. Testicular torsion is the most significant cause of testicular loss. […] Scrotal complaints are relatively common both in primary care and in the emergency department and comprise at least 0.5 percent of all emergency department visits. Testicular torsion is a true urologic emergency, and early identification is critical to prevent the need for testicular amputation. […] Testicular torsion accounts for a significant number of scrotal complaints that present to the emergency department.

• #3 Testicular Torsion: Diagnosis, Evaluation, and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2013/1215/p835.html

  Testicular torsion is a twisting of the spermatic cord and its contents and is a surgical emergency affecting 3.8 per 100,000 males younger than 18 years annually. It accounts for 10% to 15% of acute scrotal disease in children, and results in an orchiectomy rate of 42% in boys undergoing surgery for testicular torsion. […] Testicular torsion is a twisting of the spermatic cord and its contents and is a surgical emergency, with an annual incidence of 3.8 per 100,000 males younger than 18 years. 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. […] The age distribution of testicular torsion is bimodal, with one peak in the neonatal period and the second peak around puberty.

• #4 A nationwide epidemiological study of testicular torsion: Analysis of the Japanese National Database

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10923415/

  Testicular torsion is a severe urological emergency caused by the twisting of the spermatic cord. The nationwide incidence of testicular torsion in Japan has not been previously reported. […] We aimed to estimate the nationwide incidence of testicular torsion using the National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB) and examine the orchiectomy rate. […] The nationwide incidence rates of testicular torsion were 14.46, 15.09, and 15.88 per 100,000 males aged 21 years in 2018, 2019, and 2020, respectively. […] To the best of our knowledge, this study is the first to report the nationwide incidence of testicular torsion in Japan. […] Reportedly, 26% of patients with acute scrotum are diagnosed with TT. […] Herein, we aimed to improve the current knowledge regarding the epidemiology of TT.

• #5 Testicular Torsion: Diagnosis, Evaluation, and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2013/1215/p835.html

  Testicular torsion is a twisting of the spermatic cord and its contents and is a surgical emergency affecting 3.8 per 100,000 males younger than 18 years annually. It accounts for 10% to 15% of acute scrotal disease in children, and results in an orchiectomy rate of 42% in boys undergoing surgery for testicular torsion. […] Testicular torsion is a twisting of the spermatic cord and its contents and is a surgical emergency, with an annual incidence of 3.8 per 100,000 males younger than 18 years. 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. […] The age distribution of testicular torsion is bimodal, with one peak in the neonatal period and the second peak around puberty.

• #6 Testicular Torsion – A Guy’s Guide: What Every Man Needs to Know About Their Health

  https://opentextbooks.clemson.edu/btugman2021/chapter/testicular-torsion-2/

  Testicular torsion occurs when the testicles rotate and the spermatic cord twists. […] For males younger than 18 years old, the estimated yearly frequency of testicular torsion is about 4 per 100,000 (Zhao et al., 2011). […] One study performed by the Journal of Urology showed the distribution of testicular torsion to peak in the first year of life and early adolescence (Zhao et al., 2011). […] Orchiectomy rates were highest in kids younger than 10 years old, and there was an increased frequency of orchiectomy among cases in the Black race (Zhao et al., 2011). […] When surgical correction is performed within 6 hours of the start of testicular torsion, there is 90%-100% survival rate of the testicle. However, when surgery is performed within 12-24 hours from the start of testicular torsion, there is only 10% survival rate of the testicle (Keays Rosenberg, 2019). […] A study done by Childrens Health (n.d.) found that males under 18 years old waited up to 20 hours before going to the emergency room.

• #7 Testicular Torsion: Symptoms and Treatment | Doctor

  https://patient.info/doctor/torsion-of-the-testis-pro

  Torsion can occur in boys and men of any age, including prenatally. It can occur in the first year of life but most commonly in those aged 12-18 years, with peak incidence between 13-16 years. […] Annual incidence in the USA is 1 per 4,000 males younger than 25 years of age. […] There were 3,304 episodes of torsion of the testis in England in 2013/14, of which 2,501 were in children. […] 4-8% of torsions are caused by trauma.

• #8 Testicular Torsion

  https://mobile.fpnotebook.com/Uro/Testes/TstclrTrsn.htm

  Annual Incidence: 1 in 4000 males under age 25 years […] Represents 10-20% of acute Scrotal Pain in boys […] Bimodal distribution (overall age range from young children to middle aged men) […] Teens (age 12-18 years old represent 65% of cases) […] Most common in peri-pubertal teens.

• #9 A nationwide epidemiological study of testicular torsion: Analysis of the Japanese National Database | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0297888

  Testicular torsion is a severe urological emergency caused by the twisting of the spermatic cord. The nationwide incidence of testicular torsion in Japan has not been previously reported. Accordingly, we aimed to estimate the nationwide incidence of testicular torsion using the National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB) and examine the orchiectomy rate. […] The nationwide incidence rates of testicular torsion were 14.46, 15.09, and 15.88 per 100,000 males aged 21 years in 2018, 2019, and 2020, respectively. The orchiectomy rate was 7.1%. […] To the best of our knowledge, this study is the first to report the nationwide incidence of testicular torsion in Japan. […] Reportedly, 26% of patients with acute scrotum are diagnosed with TT. […] Herein, we aimed to improve the current knowledge regarding the epidemiology of TT.

• #10 A nationwide epidemiological study of testicular torsion: Analysis of the Japanese National Database | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0297888

  The nationwide incidence rate of TT was 15.13 per 100,000 males aged 21 years between 2018 and 2020. […] To the best of our knowledge, this is the first study to report the nationwide incidence rate of TT in Japan, which was 15.13 per 100,000 males aged 21 years in 20182020. […] The overall orchiectomy rate between 2018 and 2020 was 7.1%, which was significantly higher in the 04 age group than in any other groups (p 0.001). […] In summary, the present study is the first to estimate the nationwide incidence rate of TT in Japan using the NDB. The incidence rate of TT was 15.13 per 100,000 males aged 21 years and the orchiectomy rate was 7.1%.

• #11 :: ICU :: Investigative and Clinical Urology

  https://icurology.org/DOIx.php?id=10.4111/icu.20220122

  We performed a nationwide epidemiological study of testicular torsion using the National Health Insurance System database for the entire male population of Korea. […] The overall incidence of testicular torsion in males was 2.02 cases per 100,000 person-years and 6.99 cases per 100,000 person-years in males under 19 years of age. Testicular torsion most commonly occurred either in infancy or adolescence. […] This study is the first nationwide epidemiological study of testicular torsion, which contains the entire Korean population. Although the testicular salvage rate in Korea was higher compared to other countries, it is necessary to educate males under 19 years of age on the seriousness of acute testicular pain to minimize the possibility of testicular loss.

• #12 KoreaMed Synapse

  https://synapse.koreamed.org/articles/1022449

  Testicular torsion is a surgical emergency in the field of urology. […] However, the epidemiology of testicular torsion in Korea has not been studied. We performed a nationwide epidemiological study to improve knowledge of the epidemiology of testicular torsion. […] The overall incidence of testicular torsion in males was 1.1 per 100,000; However, the incidence in men less than 25 yr old was 2.9 per 100,000. […] The incidence of testicular torsion in males 1-25 yr of age has been reported as 4.5 cases per 100,000 male subjects per year in the United States. […] Our study shows that the incidence was 2.9 cases per 100,000 person years of males 25 yr of age and 1.1 cases per 100,000 person years at all ages. […] Approximately 75.7% patients with testicular torsion finally received orchiopexy in Korea. […] To minimize the possibility of orchiectomy for testicular torsion, it is important to improve public awareness to expedite presentation and provider education to hasten diagnosis and surgery.

• #13 A nationwide epidemiological study of testicular torsion: Analysis of the Japanese National Database

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10923415/

  The nationwide incidence rate of TT was 15.13 per 100,000 males aged 21 years between 2018 and 2020. […] The overall orchiectomy rate between 2018 and 2020 was 7.1%. […] The incidence rate of TT was higher between December and February (winter) than that observed during any other season, which is consistent with the findings of previous studies. […] This study revealed that left-sided TT had a significantly higher incidence rate than right-sided TT, with a 2:1 ratio. […] To the best of our knowledge, this is the first study to report the nationwide incidence rate of TT in Japan, which was 15.13 per 100,000 males aged 21 years in 20182020.

• #14 Testicular Torsion: Diagnosis, Evaluation, and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2013/1215/p835.html

  Testicular torsion is a twisting of the spermatic cord and its contents and is a surgical emergency affecting 3.8 per 100,000 males younger than 18 years annually. It accounts for 10% to 15% of acute scrotal disease in children, and results in an orchiectomy rate of 42% in boys undergoing surgery for testicular torsion. […] Testicular torsion is a twisting of the spermatic cord and its contents and is a surgical emergency, with an annual incidence of 3.8 per 100,000 males younger than 18 years. 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. […] The age distribution of testicular torsion is bimodal, with one peak in the neonatal period and the second peak around puberty.

• #15 Testicular torsion – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/testicular-torsion/

  Peak incidence: neonatal period (first 30 days of life) and during puberty (10-14 years) [1] […] Prevalence: 3.8 per 100,000 male individuals under 18 years of age (two-thirds of cases occur between 12 and 18 years of age) [2] […] Accounts for 10-15% of acute scrotal illness in children within the United States [3].

• #16 Testicular Torsion: Practice Essentials, Background, Anatomy

  https://emedicine.medscape.com/article/2036003-overview

  Extravaginal testicular torsion typically affects newborn boys, with an incidence of 1 in 7500. It constitutes 12% of all testicular torsions. Most of the torsions in this group (72%) occur prior to delivery. Postnatal torsion (normal testis at birth) within 30 days of birth comprises 28% of this cohort. It is typically unilateral and affects left and right testes equally, but bilateral torsion has been noted in 1121% of newborns and is synchronous in 80%. […] The annual incidence of intravaginal testicular torsion has been noted to be 4.5 per 100,000 males. Approximately 86% of cases occur in males older than 10 years (median age, 15 years). However, torsion has been reported in men up to the age of 78 years. […] During the COVID-19 pandemic, delayed healthcare-seeking behaviors significantly impacted the presentation of testicular torsion cases. Fear of exposure to the virus and restricted access to medical facilities led to longer symptom durations before hospital visits.

• #17 Acute scrotal pain

  https://www.racgp.org.au/afp/2013/november/acute-scrotal-pain

  Testicular torsion is ischaemia of the testicle due to rotation along the longitudinal axis of the spermatic cord. Torsion can present with varying degrees of rotation, which may explain the diverse clinical presentations encountered. The degree of torsion (range from 180720) and duration of infarction (6 hours) are key factors in salvage rates of torted testicles. It is important to note that, regardless of time to presentation and consequent diagnosis of torsion, surgical intervention should be an urgent priority. There have been a number of case reports of salvaged torted testicles even 24 hours after the onset of pain. […] Testicular torsion can occur at any age, although the diagnosis is significantly less likely in older men. It has a bimodal peak of incidence, arising most commonly in neonates and adolescents. Sixty-five per cent of presenting cases are adolescents aged 1218 years.

• #18 Imaging Testicular Torsion | Applied Radiology

  https://appliedradiology.com/articles/imaging-testicular-torsion

  Testicular torsion, or more accurately, spermatic cord torsion, is an important cause of an acute scrotum. […] Two types of testicular torsion with different peaks have been described. Extravaginal testicular torsion occurs primarily in utero or in neonates. Intravaginal testicular torsion is most common around 12 years of age but can occur at any age. The bell clapper anomaly is the primary risk factor for intravaginal torsion; the condition usually presents bilaterally and is estimated to occur in 12% of testes. […] Treatment delays resulting from repeat imaging have been associated with increased risk of orchiectomy. […] Radiologists play a critical role in the evaluation of the acute scrotum and must be able to recognize complete and incomplete testicular torsion. […] In an analysis of malpractice claims related to testicular torsion, epididymitis was the most cited misdiagnosis (61%).

• #19 Testicular Torsion | 5-Minute Emergency Consult

  https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307321/all/Testicular_Torsion

  Bimodal distribution of torsion: […] Peak incidences in infancy and adolescence […] 85% of cases occur between ages 12-18 yr, with a mean of 13 yr […] Torsion is rare after age 30 but still possible.

• #20 Testicular Torsion | 5-Minute Clinical Consult

  https://www.unboundmedicine.com/5minute/view/5-Minute-Clinical-Consult/116592/all/Testicular_Torsion?q=Alternative+Complementary+Medicine+and

  Peak incidence at age 14 years […] ~1/4,000 males before age 25 years […] 65% of cases occur in 2nd decade, with peak at age 14 years; rare beyond the age of 30 years […] Second peak in neonates (in utero torsion usually occurs around week 32 of gestation).

• #21 Testicular Torsion

  https://mobile.fpnotebook.com/Uro/Testes/TstclrTrsn.htm

  Annual Incidence: 1 in 4000 males under age 25 years […] Represents 10-20% of acute Scrotal Pain in boys […] Bimodal distribution (overall age range from young children to middle aged men) […] Teens (age 12-18 years old represent 65% of cases) […] Most common in peri-pubertal teens.

• #22 Testicular Torsion: Practice Essentials, Background, Anatomy

  https://emedicine.medscape.com/article/2036003-overview

  Extravaginal testicular torsion typically affects newborn boys, with an incidence of 1 in 7500. It constitutes 12% of all testicular torsions. Most of the torsions in this group (72%) occur prior to delivery. Postnatal torsion (normal testis at birth) within 30 days of birth comprises 28% of this cohort. It is typically unilateral and affects left and right testes equally, but bilateral torsion has been noted in 1121% of newborns and is synchronous in 80%. […] The annual incidence of intravaginal testicular torsion has been noted to be 4.5 per 100,000 males. Approximately 86% of cases occur in males older than 10 years (median age, 15 years). However, torsion has been reported in men up to the age of 78 years. […] During the COVID-19 pandemic, delayed healthcare-seeking behaviors significantly impacted the presentation of testicular torsion cases. Fear of exposure to the virus and restricted access to medical facilities led to longer symptom durations before hospital visits.

• #23 Imaging Testicular Torsion | Applied Radiology

  https://appliedradiology.com/articles/imaging-testicular-torsion

  Testicular torsion, or more accurately, spermatic cord torsion, is an important cause of an acute scrotum. […] Two types of testicular torsion with different peaks have been described. Extravaginal testicular torsion occurs primarily in utero or in neonates. Intravaginal testicular torsion is most common around 12 years of age but can occur at any age. The bell clapper anomaly is the primary risk factor for intravaginal torsion; the condition usually presents bilaterally and is estimated to occur in 12% of testes. […] Treatment delays resulting from repeat imaging have been associated with increased risk of orchiectomy. […] Radiologists play a critical role in the evaluation of the acute scrotum and must be able to recognize complete and incomplete testicular torsion. […] In an analysis of malpractice claims related to testicular torsion, epididymitis was the most cited misdiagnosis (61%).

• #24 Testicular torsion | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/testicular-torsion?lang=us

  Testicular torsion occurs when a testis torts on the spermatic cord resulting in the cutting off of blood supply. The most common symptom is acute testicular pain and the most common underlying cause, a bell-clapper deformity. The diagnosis is often made clinically but if it is in doubt, an ultrasound is helpful in confirming the diagnosis. Expedient diagnosis and surgical management are critical if the testis is to be salvaged and testicular infarction prevented. […] Anatomically there are two types of testicular torsion which occur in different age groups: extra-vaginal (supravaginal) torsion occurs at the level of the external inguinal ring and is seen in neonates; intra-vaginal torsion is the more common variety due to bell clapper deformity and typically occurs in adolescents and young adults. […] The key to successful treatment is rapid diagnosis and surgical intervention. If diagnosed early enough, the testis can be detorted with little damage. If the testis has necrosed, then orchiectomy is required.

• #25 Testicular Torsion: Practice Essentials, Background, Anatomy

  https://emedicine.medscape.com/article/2036003-overview

  Extravaginal testicular torsion typically affects newborn boys, with an incidence of 1 in 7500. It constitutes 12% of all testicular torsions. Most of the torsions in this group (72%) occur prior to delivery. Postnatal torsion (normal testis at birth) within 30 days of birth comprises 28% of this cohort. It is typically unilateral and affects left and right testes equally, but bilateral torsion has been noted in 1121% of newborns and is synchronous in 80%. […] The annual incidence of intravaginal testicular torsion has been noted to be 4.5 per 100,000 males. Approximately 86% of cases occur in males older than 10 years (median age, 15 years). However, torsion has been reported in men up to the age of 78 years. […] During the COVID-19 pandemic, delayed healthcare-seeking behaviors significantly impacted the presentation of testicular torsion cases. Fear of exposure to the virus and restricted access to medical facilities led to longer symptom durations before hospital visits.

• #26 Testicular Torsion: Diagnosis, Evaluation, and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2013/1215/p835.html

  Although no specific risk factors have been identified, poorer fixation of the neonatal tissues to one another has been implicated, and term infants with difficult or prolonged deliveries may be at higher risk. […] In older children and adults, testicular torsion is usually intravaginal (twisting of the cord within the tunica vaginalis). […] A high index of suspicion on the part of the physician is needed; children in particular may not promptly or accurately recall or describe symptom severity and duration. […] Although most patients will not require emergent intervention, a significant minority will have testicular torsion, and prompt identification and institution of therapy are crucial. […] The classic presentation of testicular torsion is sudden onset of severe unilateral testicular pain associated with nausea and vomiting.

• #27 Testicular Torsion (for Teens) | Nemours KidsHealth

  https://kidshealth.org/en/teens/torsion.html

  Testicular torsion can happen to guys of any age, but it’s most common in teens. Most of the time there’s no obvious cause. Testicular torsion can happen after an injury, during exercise, or even during sleep. […] Testicular torsion is an emergency: When it happens, a guy needs surgery fast. Saving the testicle becomes more difficult the longer the spermatic cord stays twisted. […] Most cases of testicular torsion (also called testis torsion) affect guys who have a condition called a bell clapper deformity. In most males, the testicles are attached to the scrotum, making it hard for them to twist. In males who have the bell clapper deformity, the testicles are unsecured and can move and twist in the scrotum. […] Testicular torsion can happen to boys and men of any age, but is most common in 12- to 18-year-olds. It can happen after strenuous exercise, while someone is sleeping, or after an injury to the scrotum. A lot of times, though, there is no apparent cause. […] Testicular torsion almost always requires surgery to correct. In rare cases, the doctor might be able to untwist the spermatic cord by pushing on the scrotum, but most guys will still need surgery to attach both testicles to the scrotum to prevent torsion from happening again.

• #28 A nationwide epidemiological study of testicular torsion: Analysis of the Japanese National Database

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10923415/

  The nationwide incidence rate of TT was 15.13 per 100,000 males aged 21 years between 2018 and 2020. […] The overall orchiectomy rate between 2018 and 2020 was 7.1%. […] The incidence rate of TT was higher between December and February (winter) than that observed during any other season, which is consistent with the findings of previous studies. […] This study revealed that left-sided TT had a significantly higher incidence rate than right-sided TT, with a 2:1 ratio. […] To the best of our knowledge, this is the first study to report the nationwide incidence rate of TT in Japan, which was 15.13 per 100,000 males aged 21 years in 20182020.

• #29 Frontiers | Clinical characteristics and identification of risk factors of testicular torsion in children: A retrospective study in a single institution

  https://www.frontiersin.org/journals/surgery/articles/10.3389/fsurg.2022.1040487/full

  Testicular torsion (TT) is a common urological emergency posing serious health problem in children. […] The aim of this study was to evaluate the historical features, physical examination findings, laboratory tests, and ultrasound examinations in children with TT, as well as to identify the predictors of testicular salvage in children. […] TT is significantly more common in the winter. […] Multivariate analysis showed that cause of TT, time to intervention, white blood cell (WBC), and mean platelet volume (MPV) were correlated with the risk of a surgical outcome. […] Only a small proportion of TT children received timely surgical management. […] Testicular salvage can be predicted by cause of TT, time to intervention, WBC, and MPV. […] It is important to continuously promote public awareness of TT, and improve pediatrician ability of diagnosis and therapy of TT from primary and secondary healthcare units. […] Cold weather, as well as the resultant cremasteric hyperactivity, can be risk factors for torsion in individuals with unfavorable anatomy including testicles with a greater horizontal axis. […] More TT cases were detected during winter (36.25%) in the present study.

• #30 A nationwide epidemiological study of testicular torsion: Analysis of the Japanese National Database

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10923415/

  The nationwide incidence rate of TT was 15.13 per 100,000 males aged 21 years between 2018 and 2020. […] The overall orchiectomy rate between 2018 and 2020 was 7.1%. […] The incidence rate of TT was higher between December and February (winter) than that observed during any other season, which is consistent with the findings of previous studies. […] This study revealed that left-sided TT had a significantly higher incidence rate than right-sided TT, with a 2:1 ratio. […] To the best of our knowledge, this is the first study to report the nationwide incidence rate of TT in Japan, which was 15.13 per 100,000 males aged 21 years in 20182020.

• #31 Frontiers | Clinical characteristics and identification of risk factors of testicular torsion in children: A retrospective study in a single institution

  https://www.frontiersin.org/journals/surgery/articles/10.3389/fsurg.2022.1040487/full

  Testicular torsion (TT) is a common urological emergency posing serious health problem in children. […] The aim of this study was to evaluate the historical features, physical examination findings, laboratory tests, and ultrasound examinations in children with TT, as well as to identify the predictors of testicular salvage in children. […] TT is significantly more common in the winter. […] Multivariate analysis showed that cause of TT, time to intervention, white blood cell (WBC), and mean platelet volume (MPV) were correlated with the risk of a surgical outcome. […] Only a small proportion of TT children received timely surgical management. […] Testicular salvage can be predicted by cause of TT, time to intervention, WBC, and MPV. […] It is important to continuously promote public awareness of TT, and improve pediatrician ability of diagnosis and therapy of TT from primary and secondary healthcare units. […] Cold weather, as well as the resultant cremasteric hyperactivity, can be risk factors for torsion in individuals with unfavorable anatomy including testicles with a greater horizontal axis. […] More TT cases were detected during winter (36.25%) in the present study.

• #32 A nationwide epidemiological study of testicular torsion: Analysis of the Japanese National Database

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10923415/

  The nationwide incidence rate of TT was 15.13 per 100,000 males aged 21 years between 2018 and 2020. […] The overall orchiectomy rate between 2018 and 2020 was 7.1%. […] The incidence rate of TT was higher between December and February (winter) than that observed during any other season, which is consistent with the findings of previous studies. […] This study revealed that left-sided TT had a significantly higher incidence rate than right-sided TT, with a 2:1 ratio. […] To the best of our knowledge, this is the first study to report the nationwide incidence rate of TT in Japan, which was 15.13 per 100,000 males aged 21 years in 20182020.

• #33

  https://journals.lww.com/urol/fulltext/2022/04000/testicular_torsion___symptomatology_and_outcomes.13.aspx

  Out of 101 consecutive scrotal explorations done in this time, 63.4% of all scrotal explorations were testicular torsion (n = 64). […] The peak age of testicular torsion was in the 11-15 years range and the left side is more common (65.6%). […] In all cases presented within 6 h of symptom onset, testicles were saved and salvage rates reduced with delay in presentation. […] Patients who presented after 24 h had a statistically significantly lower salvage rate of 7.7% compared to those who presented within 24 h duration, 52.2%. […] Delay in presentation to the health-care facility is the major cause of poor salvage rates in the state and its improvement requires public health interventions and health education. […] In developing countries lack of public awareness and limited health-care access increases the time delay in hospital presentation further worsening the testicular salvage rates.

• #34 Testicular Torsion: Symptoms, Causes and Treatment | Ada

  https://ada.com/conditions/testicular-torsion/

  Newborns, children and adolescents are most often affected, although it can occur at any age and without warning. […] Testicular torsion is not a common condition, with roughly only 1 in 4,000 people under the age of 25 experiencing it annually. […] Although there are established risk factors, testicular torsion can occur spontaneously without the presence of any risk factors at all.

• #35 Testicular Torsion – Core EM

  https://coreem.net/core/testicular-torsion/

  Most common cause of acute scrotal pain in prepubertal boys. […] Torsion present in 3.2% of all children presenting to the ED with scrotal pain (Ben-Israel 2010). […] Bimodal frequency: peaks in 1st year of life and again at puberty. […] Risk factors: History of cryptorchidism, horizontal testicular lie, increased spermatic cord length. […] Testicular torsion is a surgical emergency that requires immediate urologic consultation to increase the rate of tissue salvage.

• #36 Imaging Testicular Torsion | Applied Radiology

  https://appliedradiology.com/articles/imaging-testicular-torsion

  Testicular torsion, or more accurately, spermatic cord torsion, is an important cause of an acute scrotum. […] Two types of testicular torsion with different peaks have been described. Extravaginal testicular torsion occurs primarily in utero or in neonates. Intravaginal testicular torsion is most common around 12 years of age but can occur at any age. The bell clapper anomaly is the primary risk factor for intravaginal torsion; the condition usually presents bilaterally and is estimated to occur in 12% of testes. […] Treatment delays resulting from repeat imaging have been associated with increased risk of orchiectomy. […] Radiologists play a critical role in the evaluation of the acute scrotum and must be able to recognize complete and incomplete testicular torsion. […] In an analysis of malpractice claims related to testicular torsion, epididymitis was the most cited misdiagnosis (61%).

• #37 Testicular Torsion (for Teens) | Nemours KidsHealth

  https://kidshealth.org/en/teens/torsion.html

  Testicular torsion can happen to guys of any age, but it’s most common in teens. Most of the time there’s no obvious cause. Testicular torsion can happen after an injury, during exercise, or even during sleep. […] Testicular torsion is an emergency: When it happens, a guy needs surgery fast. Saving the testicle becomes more difficult the longer the spermatic cord stays twisted. […] Most cases of testicular torsion (also called testis torsion) affect guys who have a condition called a bell clapper deformity. In most males, the testicles are attached to the scrotum, making it hard for them to twist. In males who have the bell clapper deformity, the testicles are unsecured and can move and twist in the scrotum. […] Testicular torsion can happen to boys and men of any age, but is most common in 12- to 18-year-olds. It can happen after strenuous exercise, while someone is sleeping, or after an injury to the scrotum. A lot of times, though, there is no apparent cause. […] Testicular torsion almost always requires surgery to correct. In rare cases, the doctor might be able to untwist the spermatic cord by pushing on the scrotum, but most guys will still need surgery to attach both testicles to the scrotum to prevent torsion from happening again.

• #38

  https://step1.medbullets.com/reproductive/109046/testicular-torsion

  Epidemiology […] demographics […] neonatal […] adolescent years […] […] […] Risk factors […] Cryptorchidism […] Accounts for ~10% of cases of testicular torsion […] Increases risk of torsion by 10-fold compared to non-cryptorchid testes

• #39 Testicular Torsion – Core EM

  https://coreem.net/core/testicular-torsion/

  Most common cause of acute scrotal pain in prepubertal boys. […] Torsion present in 3.2% of all children presenting to the ED with scrotal pain (Ben-Israel 2010). […] Bimodal frequency: peaks in 1st year of life and again at puberty. […] Risk factors: History of cryptorchidism, horizontal testicular lie, increased spermatic cord length. […] Testicular torsion is a surgical emergency that requires immediate urologic consultation to increase the rate of tissue salvage.

• #40 Testicular torsion – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/testicular-torsion/symptoms-causes/syc-20378270

  Testicular torsion is most common between ages 12 and 18, but it can occur at any age, even before birth. […] Testicular torsion occurs when the testicle rotates on the spermatic cord, which brings blood to the testicle from the abdomen. If the testicle rotates several times, blood flow to it can be entirely blocked, causing damage more quickly. […] Testicular torsion is most common between ages 12 and 18. […] If you’ve had testicular pain that went away without treatment (intermittent torsion and detorsion), it’s likely to occur again. The more frequent the bouts of pain, the higher the risk of testicular damage. […] The condition can run in families.

• #41

  https://step2.medbullets.com/renal/120713/testicular-torsion

  Epidemiology […] Demographics […] neonatal […] adolescent years […] Risk factors […] prior history of testicular torsion […] recent trauma to the testes […] […] […] Testicular ischemia […] Infertility or subfertility […] […] […] Prognostic variable […] favorable […] rapid time to surgery

• #42 Testicular Torsion: Symptoms and Treatment | Doctor

  https://patient.info/doctor/torsion-of-the-testis-pro

  Torsion can occur in boys and men of any age, including prenatally. It can occur in the first year of life but most commonly in those aged 12-18 years, with peak incidence between 13-16 years. […] Annual incidence in the USA is 1 per 4,000 males younger than 25 years of age. […] There were 3,304 episodes of torsion of the testis in England in 2013/14, of which 2,501 were in children. […] 4-8% of torsions are caused by trauma.

• #43 Testicular Torsion – Core EM

  https://coreem.net/core/testicular-torsion/

  Most common cause of acute scrotal pain in prepubertal boys. […] Torsion present in 3.2% of all children presenting to the ED with scrotal pain (Ben-Israel 2010). […] Bimodal frequency: peaks in 1st year of life and again at puberty. […] Risk factors: History of cryptorchidism, horizontal testicular lie, increased spermatic cord length. […] Testicular torsion is a surgical emergency that requires immediate urologic consultation to increase the rate of tissue salvage.

• #44 Testicular Torsion: Diagnosis, Evaluation, and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2013/1215/p835.html

  The affected testicle can also have an abnormal horizontal orientation. […] The testes are typically detorsed from the medial to lateral side, turning the physician’s hands as if opening a book. […] Orchiectomy rates vary widely in the literature, typically ranging from 39% to 71% in most series. […] The rate of testicular loss can approach 100% in cases where the diagnosis is missed, emphasizing the necessity of maintaining a high index of suspicion for torsion in males presenting with scrotal pain. […] Contralateral orchiopexy should be performed regardless of the viability of the affected testicle.

• #45 Testicular torsion – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/testicular-torsion/symptoms-causes/syc-20378270

  Testicular torsion is most common between ages 12 and 18, but it can occur at any age, even before birth. […] Testicular torsion occurs when the testicle rotates on the spermatic cord, which brings blood to the testicle from the abdomen. If the testicle rotates several times, blood flow to it can be entirely blocked, causing damage more quickly. […] Testicular torsion is most common between ages 12 and 18. […] If you’ve had testicular pain that went away without treatment (intermittent torsion and detorsion), it’s likely to occur again. The more frequent the bouts of pain, the higher the risk of testicular damage. […] The condition can run in families.

• #46 Testicular torsion | healthdirect

  https://www.healthdirect.gov.au/testicular-torsion

  Testicular torsion is when your testicle twists around, cutting off its blood supply. […] Testicular torsion is most common in teenagers, but it can occur at any age. […] Testicular torsion is an emergency. If the blood supply is cut off for too long, your testicle could become permanently damaged. […] Testicular torsion is also more likely if it runs in your family. […] Testicular torsion is generally treated with surgery, which is done as soon as possible. […] For most people, there is no known way of preventing testicular torsion. […] The Royal Children’s Hospital provides clinical guidelines on testicular pain or swelling and torsion, advising that this is an emergency.

• #47 Testicular Torsion: Diagnosis, Evaluation, and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2013/1215/p835.html

  Although no specific risk factors have been identified, poorer fixation of the neonatal tissues to one another has been implicated, and term infants with difficult or prolonged deliveries may be at higher risk. […] In older children and adults, testicular torsion is usually intravaginal (twisting of the cord within the tunica vaginalis). […] A high index of suspicion on the part of the physician is needed; children in particular may not promptly or accurately recall or describe symptom severity and duration. […] Although most patients will not require emergent intervention, a significant minority will have testicular torsion, and prompt identification and institution of therapy are crucial. […] The classic presentation of testicular torsion is sudden onset of severe unilateral testicular pain associated with nausea and vomiting.

• #48 Degree of twisting and duration of symptoms are prognostic factors of testis salvage during episodes of testicular torsion – Howe – Translational Andrology and Urology

  https://tau.amegroups.org/article/view/16891/html

  Testicular torsion is a surgical emergency affecting 1 in 4,000 boys below the age of 25, and accounting for up to 25% of acute scrotal disease in pediatrics. […] The goal in managing testicular torsion is organ salvage. In order to maximize the chances of testicular survival, prompt diagnosis and treatment of testicular torsion is essential. […] It is well documented that there is a 4 to 8 h window of time from the onset of symptoms to surgery that is needed in order to save a torsed testicle. […] Ramachandra et al. demonstrated through multivariate analysis of the factors associated with testicular salvage, that duration of symptoms of less than 6 h was a significant predictor of testicular salvage. […] Salvage rates of over 90% are seen when surgical exploration is performed within 6 h of the onset of symptoms, decreasing to 50% when symptoms last beyond 12 h.

• #49 Acute scrotal pain

  https://www.racgp.org.au/afp/2013/november/acute-scrotal-pain

  Testicular torsion is ischaemia of the testicle due to rotation along the longitudinal axis of the spermatic cord. Torsion can present with varying degrees of rotation, which may explain the diverse clinical presentations encountered. The degree of torsion (range from 180720) and duration of infarction (6 hours) are key factors in salvage rates of torted testicles. It is important to note that, regardless of time to presentation and consequent diagnosis of torsion, surgical intervention should be an urgent priority. There have been a number of case reports of salvaged torted testicles even 24 hours after the onset of pain. […] Testicular torsion can occur at any age, although the diagnosis is significantly less likely in older men. It has a bimodal peak of incidence, arising most commonly in neonates and adolescents. Sixty-five per cent of presenting cases are adolescents aged 1218 years.

• #50 Degree of twisting and duration of symptoms are prognostic factors of testis salvage during episodes of testicular torsion – Howe – Translational Andrology and Urology

  https://tau.amegroups.org/article/view/16891/html

  Testicular torsion is a surgical emergency affecting 1 in 4,000 boys below the age of 25, and accounting for up to 25% of acute scrotal disease in pediatrics. […] The goal in managing testicular torsion is organ salvage. In order to maximize the chances of testicular survival, prompt diagnosis and treatment of testicular torsion is essential. […] It is well documented that there is a 4 to 8 h window of time from the onset of symptoms to surgery that is needed in order to save a torsed testicle. […] Ramachandra et al. demonstrated through multivariate analysis of the factors associated with testicular salvage, that duration of symptoms of less than 6 h was a significant predictor of testicular salvage. […] Salvage rates of over 90% are seen when surgical exploration is performed within 6 h of the onset of symptoms, decreasing to 50% when symptoms last beyond 12 h.

• #51 Testicular Torsion – A Guy’s Guide: What Every Man Needs to Know About Their Health

  https://opentextbooks.clemson.edu/btugman2021/chapter/testicular-torsion-2/

  Testicular torsion occurs when the testicles rotate and the spermatic cord twists. […] For males younger than 18 years old, the estimated yearly frequency of testicular torsion is about 4 per 100,000 (Zhao et al., 2011). […] One study performed by the Journal of Urology showed the distribution of testicular torsion to peak in the first year of life and early adolescence (Zhao et al., 2011). […] Orchiectomy rates were highest in kids younger than 10 years old, and there was an increased frequency of orchiectomy among cases in the Black race (Zhao et al., 2011). […] When surgical correction is performed within 6 hours of the start of testicular torsion, there is 90%-100% survival rate of the testicle. However, when surgery is performed within 12-24 hours from the start of testicular torsion, there is only 10% survival rate of the testicle (Keays Rosenberg, 2019). […] A study done by Childrens Health (n.d.) found that males under 18 years old waited up to 20 hours before going to the emergency room.

• #52 Degree of twisting and duration of symptoms are prognostic factors of testis salvage during episodes of testicular torsion – Howe – Translational Andrology and Urology

  https://tau.amegroups.org/article/view/16891/html

  Testicular torsion is a surgical emergency affecting 1 in 4,000 boys below the age of 25, and accounting for up to 25% of acute scrotal disease in pediatrics. […] The goal in managing testicular torsion is organ salvage. In order to maximize the chances of testicular survival, prompt diagnosis and treatment of testicular torsion is essential. […] It is well documented that there is a 4 to 8 h window of time from the onset of symptoms to surgery that is needed in order to save a torsed testicle. […] Ramachandra et al. demonstrated through multivariate analysis of the factors associated with testicular salvage, that duration of symptoms of less than 6 h was a significant predictor of testicular salvage. […] Salvage rates of over 90% are seen when surgical exploration is performed within 6 h of the onset of symptoms, decreasing to 50% when symptoms last beyond 12 h.

• #53 Testicular Torsion – A Guy’s Guide: What Every Man Needs to Know About Their Health

  https://pressbooks.pub/btugman2021/chapter/testicular-torsion/

  Testicular torsion occurs when the testicles rotate and the spermatic cord twists. For males younger than 18 years old, the estimated yearly frequency of testicular torsion is about 4 per 100,000 (Zhao et al., 2011). One study performed by the Journal of Urology showed the distribution of testicular torsion to peak in the first year of life and early adolescence (Zhao et al., 2011). The study also revealed that orchiectomies were performed on about 42% of boys undergoing surgery for torsion. Orchiectomy rates were highest in kids younger than 10 years old, and there was an increased frequency of orchiectomy among cases in the Black race (Zhao et al., 2011). […] When surgical correction is performed within 6 hours of the start of testicular torsion, there is 90%-100% survival rate of the testicle. However, when surgery is performed within 12-24 hours from the start of testicular torsion, there is only 10% survival rate of the testicle (Keays Rosenberg, 2019).

• #54 Testicular Torsion: Not Just in Young Men – Journal of Urological Surgery

  https://jurolsurgery.org/articles/testicular-torsion-not-just-in-young-men/doi/jus.galenos.2021.2021.0085

  Testicular torsion (TT) is a urological emergency, which requires a time-sensitive approach to diagnosis and management. TT predominantly presents with severe, sudden onset, unilateral testicular pain in men under the age of 21. […] TT has a bimodal incidence, it is seen in neonates and post pubescent boys between the ages of 12-18. The incidence of TT is approximately 3.8 in 100.000 men under the age of 25, with 6% of these occurring in men older than 31. […] The most common diagnosis for adults with acute scrotal pain over the age of 25 years is epididymo-orchitis. In this age group, TT occurs less frequently and often with a worse prognosis due to a delay in diagnosis and management leading to a greater degree of torsion of the testis. The viability of a testis torted for more than 24 hours is less than 10% leading to severe testicular ischemia.

• #55 Testicular Torsion – A Guy’s Guide: What Every Man Needs to Know About Their Health

  https://opentextbooks.clemson.edu/btugman2021/chapter/testicular-torsion-2/

  Testicular torsion occurs when the testicles rotate and the spermatic cord twists. […] For males younger than 18 years old, the estimated yearly frequency of testicular torsion is about 4 per 100,000 (Zhao et al., 2011). […] One study performed by the Journal of Urology showed the distribution of testicular torsion to peak in the first year of life and early adolescence (Zhao et al., 2011). […] Orchiectomy rates were highest in kids younger than 10 years old, and there was an increased frequency of orchiectomy among cases in the Black race (Zhao et al., 2011). […] When surgical correction is performed within 6 hours of the start of testicular torsion, there is 90%-100% survival rate of the testicle. However, when surgery is performed within 12-24 hours from the start of testicular torsion, there is only 10% survival rate of the testicle (Keays Rosenberg, 2019). […] A study done by Childrens Health (n.d.) found that males under 18 years old waited up to 20 hours before going to the emergency room.

• #56 Degree of twisting and duration of symptoms are prognostic factors of testis salvage during episodes of testicular torsion – Howe – Translational Andrology and Urology

  https://tau.amegroups.org/article/view/16891/html

  The viability of the torsed testis can be determined by the duration of symptoms along with degree of twisting, with 15 h of symptom duration and 860 degrees of torsion leading to a 50% probability of non-salvage. […] Twenty-five percent of testes undergo atrophy after orchiopexy, which proves the concept of reperfusion injury having delayed and lasting effects on testis viability.

• #57 Acute scrotal pain

  https://www.racgp.org.au/afp/2013/november/acute-scrotal-pain

  Testicular torsion is ischaemia of the testicle due to rotation along the longitudinal axis of the spermatic cord. Torsion can present with varying degrees of rotation, which may explain the diverse clinical presentations encountered. The degree of torsion (range from 180720) and duration of infarction (6 hours) are key factors in salvage rates of torted testicles. It is important to note that, regardless of time to presentation and consequent diagnosis of torsion, surgical intervention should be an urgent priority. There have been a number of case reports of salvaged torted testicles even 24 hours after the onset of pain. […] Testicular torsion can occur at any age, although the diagnosis is significantly less likely in older men. It has a bimodal peak of incidence, arising most commonly in neonates and adolescents. Sixty-five per cent of presenting cases are adolescents aged 1218 years.

• #58 Testicular torsion in Sub-Saharan Africa: a scoping review | African Journal of Urology | Full Text

  https://afju.springeropen.com/articles/10.1186/s12301-023-00384-0

  Testicular torsion is a surgical emergency caused by rotation of the vascular pedicle of the testicle around its axis. […] The primary objective of this review is to establish an epidemiological status defining the patient profile, consultation time and orchiectomy rate in the sub-Saharan context. […] In Africa, there are few data on testicular torsion, and its incidence is slightly lower than in Western countries. […] The mean time in hours between onset of symptoms and consultation was 52.5 h. […] The rate of orchiectomy performed was found in 21 publications; the average for the review as a whole was 46.4%, with extremes of 13.2% and 72%. […] The orchiectomy rate was 52.4% in studies that reported an initial referral to a health center (patient transfer), versus 36.9% in studies that did not.

• #59 Testicular torsion in Sub-Saharan Africa: a scoping review | African Journal of Urology | Full Text

  https://afju.springeropen.com/articles/10.1186/s12301-023-00384-0

  The rate of orchiectomy is highly variable in the literature: 7.6% in France, 23% in Australia, and 24.3% in Korea and 100% in Morocco. […] In this review, the average orchiectomy rate is 46.4% with extremes of 13.2% and 72%. […] The high rate of orchiectomy in our review calls for urgent community education in Africa. […] In sub-Saharan Africa, to improve the management of testicular torsion, we make the following recommendations: raise public awareness of testicular torsion, retrain health center managers on this emergency, and train general practitioners and surgeons to perform exploratory scrototomies.

• #60 Testicular Torsion – A Guy’s Guide: What Every Man Needs to Know About Their Health

  https://pressbooks.pub/btugman2021/chapter/testicular-torsion/

  Testicular torsion occurs when the testicles rotate and the spermatic cord twists. For males younger than 18 years old, the estimated yearly frequency of testicular torsion is about 4 per 100,000 (Zhao et al., 2011). One study performed by the Journal of Urology showed the distribution of testicular torsion to peak in the first year of life and early adolescence (Zhao et al., 2011). The study also revealed that orchiectomies were performed on about 42% of boys undergoing surgery for torsion. Orchiectomy rates were highest in kids younger than 10 years old, and there was an increased frequency of orchiectomy among cases in the Black race (Zhao et al., 2011). […] When surgical correction is performed within 6 hours of the start of testicular torsion, there is 90%-100% survival rate of the testicle. However, when surgery is performed within 12-24 hours from the start of testicular torsion, there is only 10% survival rate of the testicle (Keays Rosenberg, 2019).

• #61 Testicular Torsion: Diagnosis, Evaluation, and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2013/1215/p835.html

  Testicular torsion is a twisting of the spermatic cord and its contents and is a surgical emergency affecting 3.8 per 100,000 males younger than 18 years annually. It accounts for 10% to 15% of acute scrotal disease in children, and results in an orchiectomy rate of 42% in boys undergoing surgery for testicular torsion. […] Testicular torsion is a twisting of the spermatic cord and its contents and is a surgical emergency, with an annual incidence of 3.8 per 100,000 males younger than 18 years. 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. […] The age distribution of testicular torsion is bimodal, with one peak in the neonatal period and the second peak around puberty.

• #62

  https://journals.lww.com/urol/fulltext/2022/04000/testicular_torsion___symptomatology_and_outcomes.13.aspx

  Our median symptom duration for testicular torsion was 36 h and it is higher than many other countries. […] Testicular torsion is a surgical emergency where the testicles twist inside the scrotum with spermatic cord vessels getting occluded and gangrene of the testicle appears. […] Our testicular salvage rates were 28.1%. […] Delay in hospital presentation seems to be the major factor responsible for this low salvage rate. […] Our study helps us to define the exact delay in presentation after the onset of symptom in our part of the country leading to the low testicular salvage rates compared to developed nations and thus directing us to formulate better policies in public health and awareness in testicular health.

• #63

  https://journals.lww.com/cur/fulltext/2021/12000/testicular_torsion_in_adults__demographics_and.8.aspx

  Adult testicular torsion has been primarily investigated through institutional case series. To the best of our knowledge, there are no database reviews of adult testicular torsion that delineate patients who have received orchiopexy or orchiectomy. Smaller studies have investigated risk factors, but there remains minimal nationwide data on comorbid factors that may impact the need for orchiectomy especially in adults. […] We affirm that orchiectomy does not have benign consequences. Orchiectomy patients postoperatively had increased hospital stay and superficial wound infection. We hypothesize that these factors may both be related to patients being systemically ill at the time of orchiectomy and inherently having poorer blood supply either due to comorbid or concurrent conditions. […] Our study has several other limitations that are inherent to the nature of a retrospective study and limitations of a database. The ACS NSQIP database acknowledges several limitations inherent to their database.

• #64

  https://journals.lww.com/urol/fulltext/2022/04000/testicular_torsion___symptomatology_and_outcomes.13.aspx

  Our median symptom duration for testicular torsion was 36 h and it is higher than many other countries. […] Testicular torsion is a surgical emergency where the testicles twist inside the scrotum with spermatic cord vessels getting occluded and gangrene of the testicle appears. […] Our testicular salvage rates were 28.1%. […] Delay in hospital presentation seems to be the major factor responsible for this low salvage rate. […] Our study helps us to define the exact delay in presentation after the onset of symptom in our part of the country leading to the low testicular salvage rates compared to developed nations and thus directing us to formulate better policies in public health and awareness in testicular health.

• #65 Testicular torsion in Sub-Saharan Africa: a scoping review | African Journal of Urology | Full Text

  https://afju.springeropen.com/articles/10.1186/s12301-023-00384-0

  Testicular torsion is a surgical emergency caused by rotation of the vascular pedicle of the testicle around its axis. […] The primary objective of this review is to establish an epidemiological status defining the patient profile, consultation time and orchiectomy rate in the sub-Saharan context. […] In Africa, there are few data on testicular torsion, and its incidence is slightly lower than in Western countries. […] The mean time in hours between onset of symptoms and consultation was 52.5 h. […] The rate of orchiectomy performed was found in 21 publications; the average for the review as a whole was 46.4%, with extremes of 13.2% and 72%. […] The orchiectomy rate was 52.4% in studies that reported an initial referral to a health center (patient transfer), versus 36.9% in studies that did not.

• #66 Testicular torsion in Sub-Saharan Africa: a scoping review | African Journal of Urology | Full Text

  https://afju.springeropen.com/articles/10.1186/s12301-023-00384-0

  Testicular torsion is a surgical emergency caused by rotation of the vascular pedicle of the testicle around its axis. […] The primary objective of this review is to establish an epidemiological status defining the patient profile, consultation time and orchiectomy rate in the sub-Saharan context. […] In Africa, there are few data on testicular torsion, and its incidence is slightly lower than in Western countries. […] The mean time in hours between onset of symptoms and consultation was 52.5 h. […] The rate of orchiectomy performed was found in 21 publications; the average for the review as a whole was 46.4%, with extremes of 13.2% and 72%. […] The orchiectomy rate was 52.4% in studies that reported an initial referral to a health center (patient transfer), versus 36.9% in studies that did not.

• #67

  https://journals.lww.com/cur/fulltext/2021/12000/testicular_torsion_in_adults__demographics_and.8.aspx

  Most often studied in the pediatric population, testicular torsion also affects the adult male population. Little data exists on demographics, patient risk factors, and associated outcomes for the surgical management of testicular torsion. This study sought to describe differences in demographics and outcomes for those patients requiring orchiopexy or orchiectomy. […] A total of 769 patients undergoing surgical treatment of testicular torsion were captured. Most of these patients were White (46.81%) and young adults (28.33 12.04 years) and 28.8% required orchiectomy. […] Adult testicular torsion should be considered in an acute scrotum differential. Adult patients requiring orchiectomy for testicular torsion are more likely to have confounding medical conditions compared to those undergoing orchiopexy.

• #68

  https://journals.lww.com/cur/fulltext/2021/12000/testicular_torsion_in_adults__demographics_and.8.aspx

  Adult testicular torsion should be considered in an acute scrotum differential as it can occur at all ages. Adult patients requiring orchiectomy for testicular torsion are more likely to have confounding medical conditions compared to those undergoing orchiopexy. Clinically, rates of complications between the 2 procedures are small, making the decision to perform orchiopexy or orchiectomy based on the scenario, but the risk and possibility of orchiectomy should be discussed with patient preoperatively.

• #69 Testicular Torsion – A Guy’s Guide: What Every Man Needs to Know About Their Health

  https://pressbooks.pub/btugman2021/chapter/testicular-torsion/

  Testicular torsion occurs when the testicles rotate and the spermatic cord twists. For males younger than 18 years old, the estimated yearly frequency of testicular torsion is about 4 per 100,000 (Zhao et al., 2011). One study performed by the Journal of Urology showed the distribution of testicular torsion to peak in the first year of life and early adolescence (Zhao et al., 2011). The study also revealed that orchiectomies were performed on about 42% of boys undergoing surgery for torsion. Orchiectomy rates were highest in kids younger than 10 years old, and there was an increased frequency of orchiectomy among cases in the Black race (Zhao et al., 2011). […] When surgical correction is performed within 6 hours of the start of testicular torsion, there is 90%-100% survival rate of the testicle. However, when surgery is performed within 12-24 hours from the start of testicular torsion, there is only 10% survival rate of the testicle (Keays Rosenberg, 2019).

• #70 Testicular Torsion: Practice Essentials, Background, Anatomy

  https://emedicine.medscape.com/article/2036003-overview

  Extravaginal testicular torsion typically affects newborn boys, with an incidence of 1 in 7500. It constitutes 12% of all testicular torsions. Most of the torsions in this group (72%) occur prior to delivery. Postnatal torsion (normal testis at birth) within 30 days of birth comprises 28% of this cohort. It is typically unilateral and affects left and right testes equally, but bilateral torsion has been noted in 1121% of newborns and is synchronous in 80%. […] The annual incidence of intravaginal testicular torsion has been noted to be 4.5 per 100,000 males. Approximately 86% of cases occur in males older than 10 years (median age, 15 years). However, torsion has been reported in men up to the age of 78 years. […] During the COVID-19 pandemic, delayed healthcare-seeking behaviors significantly impacted the presentation of testicular torsion cases. Fear of exposure to the virus and restricted access to medical facilities led to longer symptom durations before hospital visits.

• #71 Testicular Torsion: Practice Essentials, Background, Anatomy

  https://emedicine.medscape.com/article/2036003-overview

  Despite the increased delays, orchiectomy rates indicative of severe outcomes did not consistently rise across all settings. Some regions noted a spike in testicular loss due to delayed presentations, yet others maintained stable orchiectomy rates, reflecting effective prioritization of emergency care for such cases. […] Healthcare systems adapted swiftly by modifying workflows, emphasizing rapid triaging for emergency conditions such as testicular torsion.

• #72 Testicular Torsion: Practice Essentials, Background, Anatomy

  https://emedicine.medscape.com/article/2036003-overview

  Despite the increased delays, orchiectomy rates indicative of severe outcomes did not consistently rise across all settings. Some regions noted a spike in testicular loss due to delayed presentations, yet others maintained stable orchiectomy rates, reflecting effective prioritization of emergency care for such cases. […] Healthcare systems adapted swiftly by modifying workflows, emphasizing rapid triaging for emergency conditions such as testicular torsion.

• #73 Testicular Torsion: Practice Essentials, Background, Anatomy

  https://emedicine.medscape.com/article/2036003-overview

  Despite the increased delays, orchiectomy rates indicative of severe outcomes did not consistently rise across all settings. Some regions noted a spike in testicular loss due to delayed presentations, yet others maintained stable orchiectomy rates, reflecting effective prioritization of emergency care for such cases. […] Healthcare systems adapted swiftly by modifying workflows, emphasizing rapid triaging for emergency conditions such as testicular torsion.

• #74 Imaging Testicular Torsion | Applied Radiology

  https://appliedradiology.com/articles/imaging-testicular-torsion

  Testicular torsion, or more accurately, spermatic cord torsion, is an important cause of an acute scrotum. […] Two types of testicular torsion with different peaks have been described. Extravaginal testicular torsion occurs primarily in utero or in neonates. Intravaginal testicular torsion is most common around 12 years of age but can occur at any age. The bell clapper anomaly is the primary risk factor for intravaginal torsion; the condition usually presents bilaterally and is estimated to occur in 12% of testes. […] Treatment delays resulting from repeat imaging have been associated with increased risk of orchiectomy. […] Radiologists play a critical role in the evaluation of the acute scrotum and must be able to recognize complete and incomplete testicular torsion. […] In an analysis of malpractice claims related to testicular torsion, epididymitis was the most cited misdiagnosis (61%).

• #75

  https://juniperpublishers.com/jojun/JOJUN.MS.ID.555689.php

  Prompt presentation, diagnosis and management are important factors for testicular salvage and TT needs to be out ruled in all patients presenting with acute scrotum. […] The diagnosis of TT can be challenging given the broad differential diagnosis of the acute scrotum including TT, torsion of a testicular appendage, epididymitis, hydrocele and testicular tumor. […] Our study demonstrated TT to comprise 34.8% of all acute scrotum cases and this was affecting mostly pubertal or adolescent boys. Patients who vomited were 14 times more likely to have TT than to those who did not.

• #76

  https://juniperpublishers.com/jojun/JOJUN.MS.ID.555689.php

  Testicular torsion (TT) is a urological emergency most commonly seen in adolescence, involving a decrease in blood flow in the testis resulting from torsion of the spermatic cord that can lead to gonad injury or even loss if not treated promptly. TT has an annual incidence of 3.8 per 100,000 males younger than 18 years. It accounts for approximately 10-15% of acute scrotal presentations in children and results in an orchidectomy rate of 42% of boys undergoing acute scrotal explorations. […] Delay from the time of onset of pain until scrotal exploration is important for the chances of testicular salvage. Patients under the age of 14 years are typically associated with longer delays. A lack of parental awareness of the potential sequelae of acute scrotal pain is a significant factor in delayed presentations of children to hospital.

• #77 Testicular torsion in Sub-Saharan Africa: a scoping review | African Journal of Urology | Full Text

  https://afju.springeropen.com/articles/10.1186/s12301-023-00384-0

  The rate of orchiectomy is highly variable in the literature: 7.6% in France, 23% in Australia, and 24.3% in Korea and 100% in Morocco. […] In this review, the average orchiectomy rate is 46.4% with extremes of 13.2% and 72%. […] The high rate of orchiectomy in our review calls for urgent community education in Africa. […] In sub-Saharan Africa, to improve the management of testicular torsion, we make the following recommendations: raise public awareness of testicular torsion, retrain health center managers on this emergency, and train general practitioners and surgeons to perform exploratory scrototomies.

• #78 Imaging Testicular Torsion | Applied Radiology

  https://appliedradiology.com/articles/imaging-testicular-torsion

  Testicular torsion, or more accurately, spermatic cord torsion, is an important cause of an acute scrotum. […] Two types of testicular torsion with different peaks have been described. Extravaginal testicular torsion occurs primarily in utero or in neonates. Intravaginal testicular torsion is most common around 12 years of age but can occur at any age. The bell clapper anomaly is the primary risk factor for intravaginal torsion; the condition usually presents bilaterally and is estimated to occur in 12% of testes. […] Treatment delays resulting from repeat imaging have been associated with increased risk of orchiectomy. […] Radiologists play a critical role in the evaluation of the acute scrotum and must be able to recognize complete and incomplete testicular torsion. […] In an analysis of malpractice claims related to testicular torsion, epididymitis was the most cited misdiagnosis (61%).

• #79 Testicular Torsion: Not Just in Young Men – Journal of Urological Surgery

  https://jurolsurgery.org/articles/testicular-torsion-not-just-in-young-men/doi/jus.galenos.2021.2021.0085

  Testicular torsion (TT) is a urological emergency, which requires a time-sensitive approach to diagnosis and management. TT predominantly presents with severe, sudden onset, unilateral testicular pain in men under the age of 21. […] TT has a bimodal incidence, it is seen in neonates and post pubescent boys between the ages of 12-18. The incidence of TT is approximately 3.8 in 100.000 men under the age of 25, with 6% of these occurring in men older than 31. […] The most common diagnosis for adults with acute scrotal pain over the age of 25 years is epididymo-orchitis. In this age group, TT occurs less frequently and often with a worse prognosis due to a delay in diagnosis and management leading to a greater degree of torsion of the testis. The viability of a testis torted for more than 24 hours is less than 10% leading to severe testicular ischemia.

• #80

  https://journals.lww.com/urol/fulltext/2022/04000/testicular_torsion___symptomatology_and_outcomes.13.aspx

  Our median symptom duration for testicular torsion was 36 h and it is higher than many other countries. […] Testicular torsion is a surgical emergency where the testicles twist inside the scrotum with spermatic cord vessels getting occluded and gangrene of the testicle appears. […] Our testicular salvage rates were 28.1%. […] Delay in hospital presentation seems to be the major factor responsible for this low salvage rate. […] Our study helps us to define the exact delay in presentation after the onset of symptom in our part of the country leading to the low testicular salvage rates compared to developed nations and thus directing us to formulate better policies in public health and awareness in testicular health.

• #81 Testicular Torsion – A Guy’s Guide: What Every Man Needs to Know About Their Health

  https://opentextbooks.clemson.edu/btugman2021/chapter/testicular-torsion-2/

  Testicular torsion occurs when the testicles rotate and the spermatic cord twists. […] For males younger than 18 years old, the estimated yearly frequency of testicular torsion is about 4 per 100,000 (Zhao et al., 2011). […] One study performed by the Journal of Urology showed the distribution of testicular torsion to peak in the first year of life and early adolescence (Zhao et al., 2011). […] Orchiectomy rates were highest in kids younger than 10 years old, and there was an increased frequency of orchiectomy among cases in the Black race (Zhao et al., 2011). […] When surgical correction is performed within 6 hours of the start of testicular torsion, there is 90%-100% survival rate of the testicle. However, when surgery is performed within 12-24 hours from the start of testicular torsion, there is only 10% survival rate of the testicle (Keays Rosenberg, 2019). […] A study done by Childrens Health (n.d.) found that males under 18 years old waited up to 20 hours before going to the emergency room.

• #82 Imaging Testicular Torsion | Applied Radiology

  https://appliedradiology.com/articles/imaging-testicular-torsion

  Testicular torsion, or more accurately, spermatic cord torsion, is an important cause of an acute scrotum. […] Two types of testicular torsion with different peaks have been described. Extravaginal testicular torsion occurs primarily in utero or in neonates. Intravaginal testicular torsion is most common around 12 years of age but can occur at any age. The bell clapper anomaly is the primary risk factor for intravaginal torsion; the condition usually presents bilaterally and is estimated to occur in 12% of testes. […] Treatment delays resulting from repeat imaging have been associated with increased risk of orchiectomy. […] Radiologists play a critical role in the evaluation of the acute scrotum and must be able to recognize complete and incomplete testicular torsion. […] In an analysis of malpractice claims related to testicular torsion, epididymitis was the most cited misdiagnosis (61%).

• #83 Testicular Torsion: Not Just in Young Men – Journal of Urological Surgery

  https://jurolsurgery.org/articles/testicular-torsion-not-just-in-young-men/doi/jus.galenos.2021.2021.0085

  Testicular torsion (TT) is a urological emergency, which requires a time-sensitive approach to diagnosis and management. TT predominantly presents with severe, sudden onset, unilateral testicular pain in men under the age of 21. […] TT has a bimodal incidence, it is seen in neonates and post pubescent boys between the ages of 12-18. The incidence of TT is approximately 3.8 in 100.000 men under the age of 25, with 6% of these occurring in men older than 31. […] The most common diagnosis for adults with acute scrotal pain over the age of 25 years is epididymo-orchitis. In this age group, TT occurs less frequently and often with a worse prognosis due to a delay in diagnosis and management leading to a greater degree of torsion of the testis. The viability of a testis torted for more than 24 hours is less than 10% leading to severe testicular ischemia.

• #84 Testicular Torsion: Not Just in Young Men – Journal of Urological Surgery

  https://jurolsurgery.org/articles/testicular-torsion-not-just-in-young-men/doi/jus.galenos.2021.2021.0085

  Goh et al. found that men over the age of 50 years were being misdiagnosed on the first presentation, 53.8% of the time. 57% of these men required orchidectomy, with a salvage rate of 43%. […] This case report highlights the importance of maintaining TT as a differential diagnosis for acute scrotal pain in older men. With the potential severity of TT, the need to diagnose and treat early is essential. Therefore, the treating doctor should keep a high degree of clinical suspicion of TT in men of all ages.

• #85 KoreaMed Synapse

  https://synapse.koreamed.org/articles/1022449

  Testicular torsion is a surgical emergency in the field of urology. […] However, the epidemiology of testicular torsion in Korea has not been studied. We performed a nationwide epidemiological study to improve knowledge of the epidemiology of testicular torsion. […] The overall incidence of testicular torsion in males was 1.1 per 100,000; However, the incidence in men less than 25 yr old was 2.9 per 100,000. […] The incidence of testicular torsion in males 1-25 yr of age has been reported as 4.5 cases per 100,000 male subjects per year in the United States. […] Our study shows that the incidence was 2.9 cases per 100,000 person years of males 25 yr of age and 1.1 cases per 100,000 person years at all ages. […] Approximately 75.7% patients with testicular torsion finally received orchiopexy in Korea. […] To minimize the possibility of orchiectomy for testicular torsion, it is important to improve public awareness to expedite presentation and provider education to hasten diagnosis and surgery.

• #86 Testicular torsion in Sub-Saharan Africa: a scoping review | African Journal of Urology | Full Text

  https://afju.springeropen.com/articles/10.1186/s12301-023-00384-0

  The rate of orchiectomy is highly variable in the literature: 7.6% in France, 23% in Australia, and 24.3% in Korea and 100% in Morocco. […] In this review, the average orchiectomy rate is 46.4% with extremes of 13.2% and 72%. […] The high rate of orchiectomy in our review calls for urgent community education in Africa. […] In sub-Saharan Africa, to improve the management of testicular torsion, we make the following recommendations: raise public awareness of testicular torsion, retrain health center managers on this emergency, and train general practitioners and surgeons to perform exploratory scrototomies.

• #87 Frontiers | Clinical characteristics and identification of risk factors of testicular torsion in children: A retrospective study in a single institution

  https://www.frontiersin.org/journals/surgery/articles/10.3389/fsurg.2022.1040487/full

  Testicular torsion (TT) is a common urological emergency posing serious health problem in children. […] The aim of this study was to evaluate the historical features, physical examination findings, laboratory tests, and ultrasound examinations in children with TT, as well as to identify the predictors of testicular salvage in children. […] TT is significantly more common in the winter. […] Multivariate analysis showed that cause of TT, time to intervention, white blood cell (WBC), and mean platelet volume (MPV) were correlated with the risk of a surgical outcome. […] Only a small proportion of TT children received timely surgical management. […] Testicular salvage can be predicted by cause of TT, time to intervention, WBC, and MPV. […] It is important to continuously promote public awareness of TT, and improve pediatrician ability of diagnosis and therapy of TT from primary and secondary healthcare units. […] Cold weather, as well as the resultant cremasteric hyperactivity, can be risk factors for torsion in individuals with unfavorable anatomy including testicles with a greater horizontal axis. […] More TT cases were detected during winter (36.25%) in the present study.

• #88 A Nationwide Epidemiological Study of Testicular Torsion in Korea

  https://www.jkms.org/search.php?where=aview&id=10.3346/jkms.2014.29.12.1684&code=0063JKMS&vmode=PUBREADER

  Testicular torsion is a surgical emergency in the field of urology. However, the epidemiology of testicular torsion in Korea has not been studied. We performed a nationwide epidemiological study to improve knowledge of the epidemiology of testicular torsion. The overall incidence of testicular torsion in males was 1.1 per 100,000; However, the incidence in men less than 25 yr old was 2.9 per 100,000. Adolescents showed the highest incidence. Total testicular salvage rate was 75.7% in this survey. […] The incidence of testicular torsion in males aged 26 yr was 2.9 cases per 100,000 men per year. Approximately 75.7% patients with testicular torsion finally received orchiopexy in Korea. To minimize the possibility of orchiectomy for testicular torsion, it is important to improve public awareness to expedite presentation and provider education to hasten diagnosis and surgery.

• #89 Testicular torsion in Sub-Saharan Africa: a scoping review | African Journal of Urology | Full Text

  https://afju.springeropen.com/articles/10.1186/s12301-023-00384-0

  The rate of orchiectomy is highly variable in the literature: 7.6% in France, 23% in Australia, and 24.3% in Korea and 100% in Morocco. […] In this review, the average orchiectomy rate is 46.4% with extremes of 13.2% and 72%. […] The high rate of orchiectomy in our review calls for urgent community education in Africa. […] In sub-Saharan Africa, to improve the management of testicular torsion, we make the following recommendations: raise public awareness of testicular torsion, retrain health center managers on this emergency, and train general practitioners and surgeons to perform exploratory scrototomies.

• #90 Testicular Torsion | Causes, Symptoms & Treatment

  https://www.cincinnatichildrens.org/health/t/testicular-torsion

  Testicular torsion is the twisting of the tube, called the spermatic cord, which leads to the testicle. This occurs in about one in every 4,000 males. This condition is a surgical emergency. The testicle can survive for only about six to eight hours without any blood flowing to it. After that, the tissues are damaged, and the testicle no longer works. […] Testicular torsion can happen at any age. However, it is most common in newborns or boys going through puberty. When testicular torsion happens during the newborn period, there is a very high chance that the testicle has already been severely damaged and may not be saved. […] Testicular torsion is a surgical emergency. If the twist has been present for more than eight hours, there is only a 60% chance of saving the testicle. […] We have clinical protocol in place to coordinate and expedite care between the Emergency Department, the Urology service and the Anesthesia team in the operating room. Our goal is to perform surgical repair within four hours of the patient arriving to the hospital. […] Since there are no specific causes of testicular torsion, you cannot prevent it.

• #91 Acute scrotal pain

  https://www.racgp.org.au/afp/2013/november/acute-scrotal-pain

  Individually, these clinical features are not effective enough in identifying testicular torsion. However, it would be prudent to consider torsion in any patient that presents with one or more of nausea and vomiting, acute scrotal pain of less than 24 hours, a high position of the testis or an abnormal cremasteric reflex. […] Colour Doppler sonography is indicated in equivocal cases, but has operator-dependent factors that can cause variances in sensitivity (86100%) and specificity (95100%). Importantly, a normal investigation does not rule out testicular torsion if history and examination indicate otherwise. In children, the use of ultrasonography should not delay surgical intervention if the history and examination are indicative of testicular torsion. […] Treatment involves immediate surgical exploration with detorsion (or orchidectomy) and fixation of both testes. The current literature suggests that although the rates of non-viability 12 hours post-torsion can be as high as 75%, surgical intervention should not be withheld even if the pain has been ongoing for more than 6 hours, as there is still a possibility of salvage for patients presenting up to 48 hours post-torsion. […] Manual detorsion must never substitute or delay surgery, or be attempted if surgical intervention can be arranged within a reasonable time frame. In some instances, if surgery is not feasible within 6 hours, manual detorsion may be attempted with appropriate consent and discussion.

• #92 The effectiveness of radionuclide scintigraphy in confirming testicular torsion at delayed presentation – Zondi – Translational Andrology and Urology

  https://tau.amegroups.org/article/view/118482/html

  In this study, the prevalence of TT noted on TS is relatively high (51%) compared to the other abnormal findings in the scrotum. […] This confirms that even in patients who present late, the need for surgical exploration is still warranted as there is still a possibility of salvage of the torqued testes in a few exceptional cases. […] Our results also showed that there is a high concordance between TS and U/S in the evaluation of patients with suspected TT but further studies to validate these findings between TS and U/S are warranted.

• #93 A nationwide epidemiological study of testicular torsion: Analysis of the Japanese National Database | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0297888

  Testicular torsion is a severe urological emergency caused by the twisting of the spermatic cord. The nationwide incidence of testicular torsion in Japan has not been previously reported. Accordingly, we aimed to estimate the nationwide incidence of testicular torsion using the National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB) and examine the orchiectomy rate. […] The nationwide incidence rates of testicular torsion were 14.46, 15.09, and 15.88 per 100,000 males aged 21 years in 2018, 2019, and 2020, respectively. The orchiectomy rate was 7.1%. […] To the best of our knowledge, this study is the first to report the nationwide incidence of testicular torsion in Japan. […] Reportedly, 26% of patients with acute scrotum are diagnosed with TT. […] Herein, we aimed to improve the current knowledge regarding the epidemiology of TT.

• #94 Imaging Testicular Torsion | Applied Radiology

  https://appliedradiology.com/articles/imaging-testicular-torsion

  Correlation with the patients symptoms is essential to correct diagnosis. Sudden onset of pain and severe nausea and vomiting both suggest testicular torsion. […] Scrotal exploration should be considered in the presence of high clinical suspicion for testicular torsion, even if the ultrasound findings are nonspecific. […] Zhao LC, Lautz TB, Meeks JJ, Maizels M. Pediatric testicular torsion epidemiology using a national database: incidence, risk of orchiectomy and possible measures toward improving the quality of care. J Urol. 2011;186(5):2009-2013. doi:10.1016/j.juro.2011.07.024

• #95 Acute scrotal pain

  https://www.racgp.org.au/afp/2013/november/acute-scrotal-pain

  Individually, these clinical features are not effective enough in identifying testicular torsion. However, it would be prudent to consider torsion in any patient that presents with one or more of nausea and vomiting, acute scrotal pain of less than 24 hours, a high position of the testis or an abnormal cremasteric reflex. […] Colour Doppler sonography is indicated in equivocal cases, but has operator-dependent factors that can cause variances in sensitivity (86100%) and specificity (95100%). Importantly, a normal investigation does not rule out testicular torsion if history and examination indicate otherwise. In children, the use of ultrasonography should not delay surgical intervention if the history and examination are indicative of testicular torsion. […] Treatment involves immediate surgical exploration with detorsion (or orchidectomy) and fixation of both testes. The current literature suggests that although the rates of non-viability 12 hours post-torsion can be as high as 75%, surgical intervention should not be withheld even if the pain has been ongoing for more than 6 hours, as there is still a possibility of salvage for patients presenting up to 48 hours post-torsion. […] Manual detorsion must never substitute or delay surgery, or be attempted if surgical intervention can be arranged within a reasonable time frame. In some instances, if surgery is not feasible within 6 hours, manual detorsion may be attempted with appropriate consent and discussion.

• #96 A nationwide epidemiological study of testicular torsion: Analysis of the Japanese National Database | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0297888

  The nationwide incidence rate of TT was 15.13 per 100,000 males aged 21 years between 2018 and 2020. […] To the best of our knowledge, this is the first study to report the nationwide incidence rate of TT in Japan, which was 15.13 per 100,000 males aged 21 years in 20182020. […] The overall orchiectomy rate between 2018 and 2020 was 7.1%, which was significantly higher in the 04 age group than in any other groups (p 0.001). […] In summary, the present study is the first to estimate the nationwide incidence rate of TT in Japan using the NDB. The incidence rate of TT was 15.13 per 100,000 males aged 21 years and the orchiectomy rate was 7.1%.

• #97 A nationwide epidemiological study of testicular torsion: Analysis of the Japanese National Database

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10923415/

  The nationwide incidence rate of TT was 15.13 per 100,000 males aged 21 years between 2018 and 2020. […] The overall orchiectomy rate between 2018 and 2020 was 7.1%. […] The incidence rate of TT was higher between December and February (winter) than that observed during any other season, which is consistent with the findings of previous studies. […] This study revealed that left-sided TT had a significantly higher incidence rate than right-sided TT, with a 2:1 ratio. […] To the best of our knowledge, this is the first study to report the nationwide incidence rate of TT in Japan, which was 15.13 per 100,000 males aged 21 years in 20182020.

• #98 Azthena logo with the word Azthena

  https://www.news-medical.net/health/What-Is-Testicular-Torsion.aspx

  Most cases of testicular torsion occur in young patients, that is, those under 25 years, and are typically caused by a congenital abnormality of the processus vaginalis, a blind-ended evagination of the abdominal wall that develops during fetal development. […] In theory, testicular torsion can occur at any age and in the pre-or perinatal period. However, the majority of cases occur in adolescent males during periods of growth. The most common adverse outcome is testicular loss. […] Overall, testicular torsion can occur at any age and even before birth. Treatment usually involves emergency surgery, and outcomes highly depend on the response time. If the testicle torsion is corrected within a six-hour window, testicular salvage is possible.

• #99 A nationwide epidemiological study of testicular torsion: Analysis of the Japanese National Database

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10923415/

  The nationwide incidence rate of TT was 15.13 per 100,000 males aged 21 years between 2018 and 2020. […] The overall orchiectomy rate between 2018 and 2020 was 7.1%. […] The incidence rate of TT was higher between December and February (winter) than that observed during any other season, which is consistent with the findings of previous studies. […] This study revealed that left-sided TT had a significantly higher incidence rate than right-sided TT, with a 2:1 ratio. […] To the best of our knowledge, this is the first study to report the nationwide incidence rate of TT in Japan, which was 15.13 per 100,000 males aged 21 years in 20182020.

• #100 KoreaMed Synapse

  https://synapse.koreamed.org/articles/1022449

  Testicular torsion is a surgical emergency in the field of urology. […] However, the epidemiology of testicular torsion in Korea has not been studied. We performed a nationwide epidemiological study to improve knowledge of the epidemiology of testicular torsion. […] The overall incidence of testicular torsion in males was 1.1 per 100,000; However, the incidence in men less than 25 yr old was 2.9 per 100,000. […] The incidence of testicular torsion in males 1-25 yr of age has been reported as 4.5 cases per 100,000 male subjects per year in the United States. […] Our study shows that the incidence was 2.9 cases per 100,000 person years of males 25 yr of age and 1.1 cases per 100,000 person years at all ages. […] Approximately 75.7% patients with testicular torsion finally received orchiopexy in Korea. […] To minimize the possibility of orchiectomy for testicular torsion, it is important to improve public awareness to expedite presentation and provider education to hasten diagnosis and surgery.

• #101 A nationwide epidemiological study of testicular torsion: Analysis of the Japanese National Database | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0297888

  The nationwide incidence rate of TT was 15.13 per 100,000 males aged 21 years between 2018 and 2020. […] To the best of our knowledge, this is the first study to report the nationwide incidence rate of TT in Japan, which was 15.13 per 100,000 males aged 21 years in 20182020. […] The overall orchiectomy rate between 2018 and 2020 was 7.1%, which was significantly higher in the 04 age group than in any other groups (p 0.001). […] In summary, the present study is the first to estimate the nationwide incidence rate of TT in Japan using the NDB. The incidence rate of TT was 15.13 per 100,000 males aged 21 years and the orchiectomy rate was 7.1%.

• #102 Testicular torsion in Sub-Saharan Africa: a scoping review | African Journal of Urology | Full Text

  https://afju.springeropen.com/articles/10.1186/s12301-023-00384-0

  The rate of orchiectomy is highly variable in the literature: 7.6% in France, 23% in Australia, and 24.3% in Korea and 100% in Morocco. […] In this review, the average orchiectomy rate is 46.4% with extremes of 13.2% and 72%. […] The high rate of orchiectomy in our review calls for urgent community education in Africa. […] In sub-Saharan Africa, to improve the management of testicular torsion, we make the following recommendations: raise public awareness of testicular torsion, retrain health center managers on this emergency, and train general practitioners and surgeons to perform exploratory scrototomies.

• #103 A nationwide epidemiological study of testicular torsion: Analysis of the Japanese National Database

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10923415/

  The nationwide incidence rate of TT was 15.13 per 100,000 males aged 21 years between 2018 and 2020. […] The overall orchiectomy rate between 2018 and 2020 was 7.1%. […] The incidence rate of TT was higher between December and February (winter) than that observed during any other season, which is consistent with the findings of previous studies. […] This study revealed that left-sided TT had a significantly higher incidence rate than right-sided TT, with a 2:1 ratio. […] To the best of our knowledge, this is the first study to report the nationwide incidence rate of TT in Japan, which was 15.13 per 100,000 males aged 21 years in 20182020.

• #104 Frontiers | Clinical characteristics and identification of risk factors of testicular torsion in children: A retrospective study in a single institution

  https://www.frontiersin.org/journals/surgery/articles/10.3389/fsurg.2022.1040487/full

  Testicular torsion (TT) is a common urological emergency posing serious health problem in children. […] The aim of this study was to evaluate the historical features, physical examination findings, laboratory tests, and ultrasound examinations in children with TT, as well as to identify the predictors of testicular salvage in children. […] TT is significantly more common in the winter. […] Multivariate analysis showed that cause of TT, time to intervention, white blood cell (WBC), and mean platelet volume (MPV) were correlated with the risk of a surgical outcome. […] Only a small proportion of TT children received timely surgical management. […] Testicular salvage can be predicted by cause of TT, time to intervention, WBC, and MPV. […] It is important to continuously promote public awareness of TT, and improve pediatrician ability of diagnosis and therapy of TT from primary and secondary healthcare units. […] Cold weather, as well as the resultant cremasteric hyperactivity, can be risk factors for torsion in individuals with unfavorable anatomy including testicles with a greater horizontal axis. […] More TT cases were detected during winter (36.25%) in the present study.

• #105 Testicular torsion in Sub-Saharan Africa: a scoping review | African Journal of Urology | Full Text

  https://afju.springeropen.com/articles/10.1186/s12301-023-00384-0

  Testicular torsion is a surgical emergency caused by rotation of the vascular pedicle of the testicle around its axis. […] The primary objective of this review is to establish an epidemiological status defining the patient profile, consultation time and orchiectomy rate in the sub-Saharan context. […] In Africa, there are few data on testicular torsion, and its incidence is slightly lower than in Western countries. […] The mean time in hours between onset of symptoms and consultation was 52.5 h. […] The rate of orchiectomy performed was found in 21 publications; the average for the review as a whole was 46.4%, with extremes of 13.2% and 72%. […] The orchiectomy rate was 52.4% in studies that reported an initial referral to a health center (patient transfer), versus 36.9% in studies that did not.

• #106 KoreaMed Synapse

  https://synapse.koreamed.org/articles/1022449

  Testicular torsion is a surgical emergency in the field of urology. […] However, the epidemiology of testicular torsion in Korea has not been studied. We performed a nationwide epidemiological study to improve knowledge of the epidemiology of testicular torsion. […] The overall incidence of testicular torsion in males was 1.1 per 100,000; However, the incidence in men less than 25 yr old was 2.9 per 100,000. […] The incidence of testicular torsion in males 1-25 yr of age has been reported as 4.5 cases per 100,000 male subjects per year in the United States. […] Our study shows that the incidence was 2.9 cases per 100,000 person years of males 25 yr of age and 1.1 cases per 100,000 person years at all ages. […] Approximately 75.7% patients with testicular torsion finally received orchiopexy in Korea. […] To minimize the possibility of orchiectomy for testicular torsion, it is important to improve public awareness to expedite presentation and provider education to hasten diagnosis and surgery.

• #107 Testicular torsion in Sub-Saharan Africa: a scoping review | African Journal of Urology | Full Text

  https://afju.springeropen.com/articles/10.1186/s12301-023-00384-0

  The rate of orchiectomy is highly variable in the literature: 7.6% in France, 23% in Australia, and 24.3% in Korea and 100% in Morocco. […] In this review, the average orchiectomy rate is 46.4% with extremes of 13.2% and 72%. […] The high rate of orchiectomy in our review calls for urgent community education in Africa. […] In sub-Saharan Africa, to improve the management of testicular torsion, we make the following recommendations: raise public awareness of testicular torsion, retrain health center managers on this emergency, and train general practitioners and surgeons to perform exploratory scrototomies.

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