Materiały źródłowe

• #1 Testicular Torsion | AAFP

  https://www.aafp.org/pubs/afp/issues/2006/1115/p1739.html

  Each year, testicular torsion affects one in 4,000 males younger than 25 years. […] The finding of an ipsilateral absent cremasteric reflex is the most accurate sign of testicular torsion. […] Diagnosis of testicular torsion is based on the finding of decreased or absent blood flow on the ipsilateral side. […] Torsion initially obstructs venous return. Subsequent equalization of venous and arterial pressures compromises arterial flow, resulting in testicular ischemia. […] The degree of ischemia depends on the duration of torsion and the degree of rotation of the spermatic cord. […] Ischemia can occur as soon as four hours after torsion and is almost certain after 24 hours. […] Greater degrees of rotation lead to a more rapid onset of ischemia, but the degree of rotation rarely can be determined without surgical intervention.

• #2 Testicular torsion: A case report | Cirugía y Cirujanos (English Edition)

  https://www.elsevier.es/en-revista-cirugia-cirujanos-english-edition–237-articulo-testicular-torsion-a-case-report-S2444050717300773

  The acute scrotum is an emergency. Testicular torsion represents approximately 25% of the causes. The annual incidence of testicular torsion is approximately 1/4000 persons under 25 years, with highest prevalence between 12 and 18 years old. It usually occurs without apparent cause, but it has been associated with anatomical, traumatic, and environmental factors, among others. […] In general there is no apparent causes, but several factors relating to the deformity have been described in bell clapper testis, where there is an abnormal adherence of the tunica vaginalis to the testicle, and this results in an increase in the mobility of the testicle inside the tunica vaginalis. Other associated factors are: the increase in testicular volume, testicular tumours, testicle with a horizontal position, a history of cryptorchidism, spermatic cord with a long intrascrotal section, high or proximal insertion of the tunica vaginalis to the spermatic cord, trauma and recent exercise. Environmental factors, such as low temperatures, have also been associated with testicular torsion. […] Testicular torsion should always be considered as one of the main causes of acute scrotal pain. Delayed diagnosis should be avoided and the patient should always be referred for a further level of treatment since its delay is directly related to the percentage of testicular salvage or loss.

• #3 Testicular Torsion – StatPearls – NCBI Bookshelf

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

  Testicular torsion is caused by the twisting of the blood supply and spermatic cord. The tunica vaginalis is usually solidly adhered to the posterolateral aspect of the testicle, and within it, the spermatic cord is not mobile. If the attachment of the tunica vaginalis is high, then this allows the spermatic cord to twist inside, leading to intravaginal torsion. This defect is referred to as the bell clapper deformity and is bilateral in at least 2/5ths of cases. […] As the testicle twists around the spermatic cord, venous blood flow is cut off, leading to venous congestion and ischemia of the testicle. The testicle will become tender, swollen, and possibly erythematous. As the testicle further twists, the arterial blood supply is cut off, which leads to further testicular ischemia and, eventually, necrosis. […] In most individuals, the testicle rotates between 90-180 degrees and compromises blood flow. Complete torsion is rare and quickly decreases the viability of the testes. Salvage is possible if the torsion is less than 8 hours, but rare if more than 24 hours have elapsed.

• #4 Testicular Torsion – Signs – Emergency Management – TeachMeSurgery

  https://teachmesurgery.com/urology/genital-tract/testicular-torsion/

  Testicular torsion occurs when the spermatic cord and its contents twists within the tunica vaginalis, compromising the blood supply to the testicle. […] Torsion occurs when a mobile testis rotates on the spermatic cord. Initially, this blocks venous return as the veins are thin walled, causing venous congestion and subsequent oedema. As congestion worsens, rising pressure then restricts arterial blood flow, cutting off oxygen supply and leading to ischemic injury. […] Males with a horizontal lie to their testes, often termed a bell-clapper deformity, are more prone to developing testicular torsion. In this anatomical variant, the testis lacks normal attachment of the tunica vaginalis and often the gubernaculum, making it more mobile and significantly increasing the likelihood of twisting on the cord structures.

• #5 Testicular Torsion | AAFP

  https://www.aafp.org/pubs/afp/issues/2006/1115/p1739.html

  Each year, testicular torsion affects one in 4,000 males younger than 25 years. […] The finding of an ipsilateral absent cremasteric reflex is the most accurate sign of testicular torsion. […] Diagnosis of testicular torsion is based on the finding of decreased or absent blood flow on the ipsilateral side. […] Torsion initially obstructs venous return. Subsequent equalization of venous and arterial pressures compromises arterial flow, resulting in testicular ischemia. […] The degree of ischemia depends on the duration of torsion and the degree of rotation of the spermatic cord. […] Ischemia can occur as soon as four hours after torsion and is almost certain after 24 hours. […] Greater degrees of rotation lead to a more rapid onset of ischemia, but the degree of rotation rarely can be determined without surgical intervention.

• #6 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. Prompt diagnosis and treatment of testicular torsion is essential for testicular viability. At surgical exploration, the spermatic cord is seen twisted a variable number of times around its longitudinal axis. […] There is scant data regarding the degree of twisting found at surgical exploration and its association with testis outcomes. […] The purpose of our study is to further explore how the degree of torsion factors into testicular outcome. It is hypothesized that the greater number of twists of the spermatic cord would offer more obstruction of the vasculature and thus a lower salvage rate based on immediate intraoperative findings (orchiectomy) along with delayed atrophy of the testicle at follow-up. […] A non-parametric Wilcoxon rank/Kruskal-Wallis analysis confirmed that non-salvageable testicles tended to have significantly higher degrees of twisting when compared to their viable counterparts.

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

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

  Testicular torsion can be distinguished as two separate mechanisms, extravaginal and intravaginal, depending on whether the torsion includes the tunica vaginalis or occurs within the tunica vaginalis. Perinatal testicular torsion is also synonymous with extravaginal torsion, as it occurs exclusively in this stage of life. […] In extravaginal torsion, the entire cord including the tunica vaginalis becomes twisted, as it has not yet become fixed within the scrotum. […] Intravaginal torsion occurs when there is an abnormally high fixation of the tunica vaginalis to the spermatic cord (bell clapper deformity), allowing the spermatic cord and testis to twist within the tunica vaginalis. […] The significant consequence of torsion of the spermatic cord is testicular ischemia. The magnitude of ischemia is determined by both the degree of rotation and the duration of the torsion.

• #8 Pediatric Testicular Torsion: Practice Essentials, Anatomy, Pathophysiology

  https://emedicine.medscape.com/article/2035074-overview

  Pediatric testicular torsion is an acute vascular event in which the spermatic cord becomes twisted on its axis, so that the blood flow to or from the testicle becomes interrupted. This results in ischemic injury and infarction. Over time, the condition may lead to loss of the testis. […] Testicular torsion can take place either inside the tunica vaginalis (intravaginal) or outside it (extravaginal). The distinction is important because the two forms of torsion are associated with different ages of presentation and etiologies. Intravaginal testicular torsion is far more common and represents almost all torsion events in older boys. […] A rotational twisting of the spermatic cord is the basis of all torsion events. When the twist is sufficient to obstruct arterial inflow (and prevent venous blood return), testicular ischemia results, most likely as a consequence of increased intratesticular pressure. If the duration of ischemia is long enough, infarction (loss of testicular tissue) results. Lesser degrees of cord twisting may result in obstruction of venous outflow, causing congestion and swelling of the testis without frank infarction.

• #9 Pediatric Testicular Torsion: Practice Essentials, Anatomy, Pathophysiology

  https://emedicine.medscape.com/article/2035074-overview

  In the newborn, the scrotal parietal tunica vaginalis has not yet fully adhered to the outer tissues of the scrotum. Thus, the entire testes, tunica vaginalis, and gubernaculum may twist together within the scrotum, resulting in an extravaginal torsion. This is the most common form of torsion in the perinatal period.

• #10 Testicular torsion-detorsion syndrome | Radiology Reference Article | Radiopaedia.org

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

  Testicular torsion-detorsion syndrome or intermittent testicular torsion refers to acute and periodic testicular pain due to limited blood flow, integrated with asymptomatic periods. […] In neonates, the most common form of torsion is extravaginal or supravaginal where the whole content of the hemiscrotum twists around the spermatic cord at the level of the external inguinal ring. […] In young adults or adolescents, the more expected torsion is intravaginal. The most common underlying abnormality is the so-called bell clapper deformity. This deformity is noted in 5-16% of males and is bilateral in 66-100% of cases. […] Given that torsion-detorsion syndrome ultimately will progress to acute testicular infarction, an elective orchiopexy in smaller series has shown an excellent outcome.

• #11 Testicular Torsion – StatPearls – NCBI Bookshelf

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

  Testicular torsion is caused by the twisting of the blood supply and spermatic cord. The tunica vaginalis is usually solidly adhered to the posterolateral aspect of the testicle, and within it, the spermatic cord is not mobile. If the attachment of the tunica vaginalis is high, then this allows the spermatic cord to twist inside, leading to intravaginal torsion. This defect is referred to as the bell clapper deformity and is bilateral in at least 2/5ths of cases. […] As the testicle twists around the spermatic cord, venous blood flow is cut off, leading to venous congestion and ischemia of the testicle. The testicle will become tender, swollen, and possibly erythematous. As the testicle further twists, the arterial blood supply is cut off, which leads to further testicular ischemia and, eventually, necrosis. […] In most individuals, the testicle rotates between 90-180 degrees and compromises blood flow. Complete torsion is rare and quickly decreases the viability of the testes. Salvage is possible if the torsion is less than 8 hours, but rare if more than 24 hours have elapsed.

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

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

  Testicular torsion can be distinguished as two separate mechanisms, extravaginal and intravaginal, depending on whether the torsion includes the tunica vaginalis or occurs within the tunica vaginalis. Perinatal testicular torsion is also synonymous with extravaginal torsion, as it occurs exclusively in this stage of life. […] In extravaginal torsion, the entire cord including the tunica vaginalis becomes twisted, as it has not yet become fixed within the scrotum. […] Intravaginal torsion occurs when there is an abnormally high fixation of the tunica vaginalis to the spermatic cord (bell clapper deformity), allowing the spermatic cord and testis to twist within the tunica vaginalis. […] The significant consequence of torsion of the spermatic cord is testicular ischemia. The magnitude of ischemia is determined by both the degree of rotation and the duration of the torsion.

• #13 Testicular Torsion

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

  Spermatic cord twists around its longitudinal axis. […] Initial venous obstruction and congestion results in Testicular Swelling. […] Decreased arterial perfusion to Testicle, followed by Testicle ischemia and infarction. […] „Bell Clapper” deformity results in excessive Testicle mobility, allowing spermatic cord to twist. […] Responsible for torsion in 90% of cases. […] Testicular Torsion in this case occurs completely within tunica vaginalis (intravaginal torsion). […] Extravaginal torsion in neonates (external to tunica vaginalis). […] Unilateral defect of incomplete attachment (unclear etiology). […] Pain may have improved or resolved at presentation despite persistent Testicular Torsion. […] Nerve becomes ischemic on twisting with vascular supply. […] Pain recurs on testicular infarction with local inflammation.

• #14 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 underlying abnormality is the so-called bell clapper deformity which is the abnormally high attachment of the tunica vaginalis to the spermatic cord, allowing the testis and adjacent epididymis to move more freely, and thus places it at risk of twisting around the spermatic cord. […] Initially, torsion is sufficient only to obstruct venous outflow (incomplete torsion, less than 360 degrees), resulting in the gradual increase in intratesticular pressure and resistance. Over time and with an additional twisting of the cord (greater than 360 degrees), the arterial inflow is also obstructed, and the testis becomes entirely ischemic.

• #15 Testicular Torsion in the Emergency Room: A Review of Detection and Ma | OAEM

  https://www.dovepress.com/testicular-torsion-in-the-emergency-room-a-review-of-detection-and-man-peer-reviewed-fulltext-article-OAEM

  The clapper-bell deformity is commonly noted in patients with testicular torsion. Normally, the tunica vaginalis attaches directly to the posterolateral part of the testis. With the clapper-bell deformity the epididymis, distal spermatic cord and testis are entirely surrounded by the tunica vaginalis, allowing the testis to hang freely with the ability to turn and swing inside the tunica vaginalis and thereby predisposing the individual to testicular torsion. […] Manual detorsion was first described in 1893 to reverse ischemia and provide instantaneous pain relief. It can be considered a time buying procedure and a prelude to surgical intervention that may limit testicular infarction while preparations are being made for surgical exploration. […] In the suspected diagnosis of torsion, urgent scrotal exploration is the treatment of choice to salvage a possible ischemic testis. Non-viable testis should be removed (orchiectomy) to prevent formation of anti-sperm antibodies and thus compromising the functionality of the healthy contralateral testis.

• #16 Testicular Torsion – StatPearls – NCBI Bookshelf

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

  Testicular torsion is caused by the twisting of the blood supply and spermatic cord. The tunica vaginalis is usually solidly adhered to the posterolateral aspect of the testicle, and within it, the spermatic cord is not mobile. If the attachment of the tunica vaginalis is high, then this allows the spermatic cord to twist inside, leading to intravaginal torsion. This defect is referred to as the bell clapper deformity and is bilateral in at least 2/5ths of cases. […] As the testicle twists around the spermatic cord, venous blood flow is cut off, leading to venous congestion and ischemia of the testicle. The testicle will become tender, swollen, and possibly erythematous. As the testicle further twists, the arterial blood supply is cut off, which leads to further testicular ischemia and, eventually, necrosis. […] In most individuals, the testicle rotates between 90-180 degrees and compromises blood flow. Complete torsion is rare and quickly decreases the viability of the testes. Salvage is possible if the torsion is less than 8 hours, but rare if more than 24 hours have elapsed.

• #17 Testicular torsion-detorsion syndrome | Radiology Reference Article | Radiopaedia.org

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

  Testicular torsion-detorsion syndrome or intermittent testicular torsion refers to acute and periodic testicular pain due to limited blood flow, integrated with asymptomatic periods. […] In neonates, the most common form of torsion is extravaginal or supravaginal where the whole content of the hemiscrotum twists around the spermatic cord at the level of the external inguinal ring. […] In young adults or adolescents, the more expected torsion is intravaginal. The most common underlying abnormality is the so-called bell clapper deformity. This deformity is noted in 5-16% of males and is bilateral in 66-100% of cases. […] Given that torsion-detorsion syndrome ultimately will progress to acute testicular infarction, an elective orchiopexy in smaller series has shown an excellent outcome.

• #18 Testicular torsion-detorsion syndrome | Radiology Reference Article | Radiopaedia.org

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

  Testicular torsion-detorsion syndrome or intermittent testicular torsion refers to acute and periodic testicular pain due to limited blood flow, integrated with asymptomatic periods. […] In neonates, the most common form of torsion is extravaginal or supravaginal where the whole content of the hemiscrotum twists around the spermatic cord at the level of the external inguinal ring. […] In young adults or adolescents, the more expected torsion is intravaginal. The most common underlying abnormality is the so-called bell clapper deformity. This deformity is noted in 5-16% of males and is bilateral in 66-100% of cases. […] Given that torsion-detorsion syndrome ultimately will progress to acute testicular infarction, an elective orchiopexy in smaller series has shown an excellent outcome.

• #19 Mechanisms of testicular torsion and potential – ProQuest

  https://www.proquest.com/scholarly-journals/mechanisms-testicular-torsion-potential/docview/1789537612/se-2

  Testicular torsion 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 result in gonad injury or even loss if not treated in time. […] Testicular ischaemia-reperfusion injury represents the principle pathophysiology of testicular torsion, with ischaemia caused by twisting of the spermatic cord, and reperfusion on its subsequent release. […] Many cellular and molecular mechanisms are involved in ischaemia-reperfusion injury following testicular torsion. […] Numerous substances have been proposed as important in the prevention of post-ischaemia-reperfusion testicular injury. […] A range of chemicals and drugs has been successfully tested in animal models for the purpose of mitigating the dangerous effects of ischaemia-reperfusion in testis torsion.

• #20 Testicular Torsion (Surgical emergency) .pptx

  https://www.slideshare.net/slideshow/testicular-torsion-surgical-emergency-pptx/269444824

  Testicular torsion refers to the torsion of the spermatic cord structures and subsequent loss of the blood supply to the ipsilateral testicle. Urological emergency; early diagnosis and treatment are vital. Mainly disease of Neonates, Adolescents. The rate of testicular viability decreases significantly after 6 hours from onset of symptoms. […] Torsion occurs as the testicle rotates between 90 and 180, compromising blood flow to and from the testicle. Complete torsion usually occurs when the testicle twists 360 or more; incomplete or partial torsion occurs with lesser degrees of rotation. The degree of torsion may extend to 720. […] The twisting of the testicle causes venous occlusion and engorgement as well as arterial ischemia and infarction of the testicle. The degree of torsion the testicle endures may play a role in the viability of the testicle over time.

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

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

  Depending on the severity of ischemia, the morphologic changes range from vascular congestion to hemorrhagic necrosis of the testis. […] Animal studies have demonstrated a loss of all spermatogenic and Sertoli cells after six hours, and loss of Leydig cells after 10 hours of complete absence of vascular flow. […] Clinically, 10 hours of torsion greater than 360 degrees will result in testicular atrophy for most patients. […] After the torsion has been reduced, reperfusion injury can further damage cellular DNA via reactive oxygen species causing lipid peroxidation, which leads to cellular and mitochondrial membrane disruption. […] Under normal physiologic conditions, the testis is isolated by a blood-testis barrier. When this barrier is disrupted, the immune system can develop antibodies against sperm antigens.

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

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

  Depending on the severity of ischemia, the morphologic changes range from vascular congestion to hemorrhagic necrosis of the testis. […] Animal studies have demonstrated a loss of all spermatogenic and Sertoli cells after six hours, and loss of Leydig cells after 10 hours of complete absence of vascular flow. […] Clinically, 10 hours of torsion greater than 360 degrees will result in testicular atrophy for most patients. […] After the torsion has been reduced, reperfusion injury can further damage cellular DNA via reactive oxygen species causing lipid peroxidation, which leads to cellular and mitochondrial membrane disruption. […] Under normal physiologic conditions, the testis is isolated by a blood-testis barrier. When this barrier is disrupted, the immune system can develop antibodies against sperm antigens.

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

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

  Depending on the severity of ischemia, the morphologic changes range from vascular congestion to hemorrhagic necrosis of the testis. […] Animal studies have demonstrated a loss of all spermatogenic and Sertoli cells after six hours, and loss of Leydig cells after 10 hours of complete absence of vascular flow. […] Clinically, 10 hours of torsion greater than 360 degrees will result in testicular atrophy for most patients. […] After the torsion has been reduced, reperfusion injury can further damage cellular DNA via reactive oxygen species causing lipid peroxidation, which leads to cellular and mitochondrial membrane disruption. […] Under normal physiologic conditions, the testis is isolated by a blood-testis barrier. When this barrier is disrupted, the immune system can develop antibodies against sperm antigens.

• #24 Protective Effects of Capsaicin on Experimental Testicular Torsion and Detorsion Injury – Journal of Urological Surgery

  https://jurolsurgery.org/articles/protective-effects-of-capsaicin-on-experimental-testicular-torsion-and-detorsion-injury/doi/jus.galenos.2022.2022.0011

  Testicular torsion is one of the most common genital diseases in males in adolescence and it should be treated as soon as possible without ipsilateral testicular dysfunction. […] Torsion occurs when the blood flow to the region decreases or is stopped completely. Increasing edema leads to arterial obstruction and subsequently results in ischemia and gonadal necrosis. […] Because of ischemia in the tissue, it causes cell death, energy deficiency, deterioration in signal pathways and accumulation of reactive oxygen species (ROS). […] While testicular torsion causes ischemic damage in the tissue, detorsion causes reperfusion damage, which is the main cause of tissue damage. […] Studies have shown that the critical ischemia time should not be more than 4 h to avoid irreversible damage to the germinal and tubular epithelium in rat testicles.

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

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

  Depending on the severity of ischemia, the morphologic changes range from vascular congestion to hemorrhagic necrosis of the testis. […] Animal studies have demonstrated a loss of all spermatogenic and Sertoli cells after six hours, and loss of Leydig cells after 10 hours of complete absence of vascular flow. […] Clinically, 10 hours of torsion greater than 360 degrees will result in testicular atrophy for most patients. […] After the torsion has been reduced, reperfusion injury can further damage cellular DNA via reactive oxygen species causing lipid peroxidation, which leads to cellular and mitochondrial membrane disruption. […] Under normal physiologic conditions, the testis is isolated by a blood-testis barrier. When this barrier is disrupted, the immune system can develop antibodies against sperm antigens.

• #26 Protective Effects of Capsaicin on Experimental Testicular Torsion and Detorsion Injury – Journal of Urological Surgery

  https://jurolsurgery.org/articles/protective-effects-of-capsaicin-on-experimental-testicular-torsion-and-detorsion-injury/doi/jus.galenos.2022.2022.0011

  Studies have shown that ROS can have adverse effects by disrupting the structural elements of the tissue and it has been reported that these effects can be reduced with antioxidant therapy. […] CAP protects against testicular damage through mTOR-dependent mechanism. […] The present study, CAP was given subcutaneously 30 min before reperfusion, showed effects on biochemical and histopathological levels in decreasing reperfusion injury in the testis. […] The present findings show that CAP-treated group had decreased tubular damage, near-normal seminiferous tubules and spermatogenic cell lines in the tubule wall. […] The results of this study indicate that CAP treatment has a protective effect against I/R damage in testicular torsion with biochemical and histological examinations.

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

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

  Depending on the severity of ischemia, the morphologic changes range from vascular congestion to hemorrhagic necrosis of the testis. […] Animal studies have demonstrated a loss of all spermatogenic and Sertoli cells after six hours, and loss of Leydig cells after 10 hours of complete absence of vascular flow. […] Clinically, 10 hours of torsion greater than 360 degrees will result in testicular atrophy for most patients. […] After the torsion has been reduced, reperfusion injury can further damage cellular DNA via reactive oxygen species causing lipid peroxidation, which leads to cellular and mitochondrial membrane disruption. […] Under normal physiologic conditions, the testis is isolated by a blood-testis barrier. When this barrier is disrupted, the immune system can develop antibodies against sperm antigens.

• #28 Testicular Torsion: Diagnosis and Treatment

  https://www.urology-textbook.com/testicular-torsion.html

  Testicular torsion is a mostly spontaneous torsion of the testicle around the spermatic cord with consecutive ischemia. […] Abnormal mobility of the testicle causes testicular torsion. Cremasteric contraction causes a rotational force to the testes and can induce testicular torsion, as also manipulation or testicular trauma may trigger a torsion. […] The torsion of the testis leads to impaired venous drainage and hemorrhagic necrosis of the testicular tissue. The testicular tissue is irreversibly damaged after eight hours of complete torsion. […] Subfertility may develop after testicular torsion; the prevalence and mechanisms are unclear and controversial. Possible mechanisms are reflectory sympathetic vasocontriction with subsequent ischemia and damage to the blood-testis barrier with formation of anti-sperm antibodies. […] Untreated testicular torsion leads to hemorrhagic necrosis of the testis since the torsion of the spermatic cord first compresses the venous supply.

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

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

  A proposed hypothesis for post-torsion reduction of contralateral testicular vitality is that torsion may result in reflex vasoconstriction involving the contralateral testis, which may contribute to contralateral testicular injury. […] Retention of the torsed testis in the body for a prolonged time can lead to reduction in spermatogonia and spermatids in the contralateral testis.

• #30 :: WJMH :: World Journal of Men’s Health

  https://wjmh.org/DOIx.php?id=10.5534/wjmh.190037

  Evidence is contradictory regarding how the torsed testis should be surgically managed. […] The effect of ipsilateral reperfusion injury after detorsion is thought to manifest itself bilaterally and simultaneously result in a contralateral reflectory sympathetic mediated vasoconstriction of the testicular blood vessels. […] Animal studies have generally demonstrated TT’s negative contralateral effect in that the contralateral testis seems to be affected by reperfusion injury, potentially causing long-term damage. […] In conclusion, it is possible that the above mentioned hypotheses of contralateral damage after TT are overlapping and that contralateral testis damage is a result of a multifactorial process.

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

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

  A proposed hypothesis for post-torsion reduction of contralateral testicular vitality is that torsion may result in reflex vasoconstriction involving the contralateral testis, which may contribute to contralateral testicular injury. […] Retention of the torsed testis in the body for a prolonged time can lead to reduction in spermatogonia and spermatids in the contralateral testis.

• #32 :: WJMH :: World Journal of Men’s Health

  https://wjmh.org/DOIx.php?id=10.5534/wjmh.190037

  Evidence is contradictory regarding how the torsed testis should be surgically managed. […] The effect of ipsilateral reperfusion injury after detorsion is thought to manifest itself bilaterally and simultaneously result in a contralateral reflectory sympathetic mediated vasoconstriction of the testicular blood vessels. […] Animal studies have generally demonstrated TT’s negative contralateral effect in that the contralateral testis seems to be affected by reperfusion injury, potentially causing long-term damage. […] In conclusion, it is possible that the above mentioned hypotheses of contralateral damage after TT are overlapping and that contralateral testis damage is a result of a multifactorial process.

• #33 :: WJMH :: World Journal of Men’s Health

  https://wjmh.org/DOIx.php?id=10.5534/wjmh.190037

  Evidence is contradictory regarding how the torsed testis should be surgically managed. […] The effect of ipsilateral reperfusion injury after detorsion is thought to manifest itself bilaterally and simultaneously result in a contralateral reflectory sympathetic mediated vasoconstriction of the testicular blood vessels. […] Animal studies have generally demonstrated TT’s negative contralateral effect in that the contralateral testis seems to be affected by reperfusion injury, potentially causing long-term damage. […] In conclusion, it is possible that the above mentioned hypotheses of contralateral damage after TT are overlapping and that contralateral testis damage is a result of a multifactorial process.

• #34 :: WJMH :: World Journal of Men’s Health

  https://wjmh.org/DOIx.php?id=10.5534/wjmh.190037

  Torsion of the spermatic cord is a urological emergency that must be treated with acute surgery. […] Testis tissue survival after TT is dependent on the degree and duration of TT. TT has been demonstrated to cause long-term decrease in sperm motility and reduce overall sperm counts. […] Long-term damage to the ipsilateral testis after TT is thought to be caused by the period of ischemia during torsion and by oxidative stress after detorsion. […] The primary endocrine function of the testes is production of testosterone. […] Current evidence does not suggest that testicular endocrine function is affected by TT. […] Although endocrine function seems unhindered by TT, there is evidence to suggest that TT may negatively impact a man’s fertility measured by semen parameter changes. […] Overall, it seems that at long-term follow-up after TT some patients experience decreased sperm motility and reduced overall sperm counts possibly rendering them subfertile.

• #35 :: WJMH :: World Journal of Men’s Health

  https://wjmh.org/DOIx.php?id=10.5534/wjmh.190037

  Evidence is contradictory regarding how the torsed testis should be surgically managed. […] The effect of ipsilateral reperfusion injury after detorsion is thought to manifest itself bilaterally and simultaneously result in a contralateral reflectory sympathetic mediated vasoconstriction of the testicular blood vessels. […] Animal studies have generally demonstrated TT’s negative contralateral effect in that the contralateral testis seems to be affected by reperfusion injury, potentially causing long-term damage. […] In conclusion, it is possible that the above mentioned hypotheses of contralateral damage after TT are overlapping and that contralateral testis damage is a result of a multifactorial process.

• #36 :: WJMH :: World Journal of Men’s Health

  https://wjmh.org/DOIx.php?id=10.5534/wjmh.190037

  Torsion of the spermatic cord is a urological emergency that must be treated with acute surgery. […] Testis tissue survival after TT is dependent on the degree and duration of TT. TT has been demonstrated to cause long-term decrease in sperm motility and reduce overall sperm counts. […] Long-term damage to the ipsilateral testis after TT is thought to be caused by the period of ischemia during torsion and by oxidative stress after detorsion. […] The primary endocrine function of the testes is production of testosterone. […] Current evidence does not suggest that testicular endocrine function is affected by TT. […] Although endocrine function seems unhindered by TT, there is evidence to suggest that TT may negatively impact a man’s fertility measured by semen parameter changes. […] Overall, it seems that at long-term follow-up after TT some patients experience decreased sperm motility and reduced overall sperm counts possibly rendering them subfertile.

• #37 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. Prompt diagnosis and treatment of testicular torsion is essential for testicular viability. At surgical exploration, the spermatic cord is seen twisted a variable number of times around its longitudinal axis. […] There is scant data regarding the degree of twisting found at surgical exploration and its association with testis outcomes. […] The purpose of our study is to further explore how the degree of torsion factors into testicular outcome. It is hypothesized that the greater number of twists of the spermatic cord would offer more obstruction of the vasculature and thus a lower salvage rate based on immediate intraoperative findings (orchiectomy) along with delayed atrophy of the testicle at follow-up. […] A non-parametric Wilcoxon rank/Kruskal-Wallis analysis confirmed that non-salvageable testicles tended to have significantly higher degrees of twisting when compared to their viable counterparts.

• #38 Analysis of factors associated with delayed diagnosis and treatment of testicular torsion in 1005 cases from Chongqing city, China: a cross-sectional study | Scientific Reports

  https://www.nature.com/articles/s41598-023-49820-9

  This study aimed to investigate the clinical and social factors of delayed treatment for testicular torsion (TT) and to explore the risk factors of testicular excision in China. […] Timely diagnosis and surgical intervention of TT are crucial to prevent testicular ischemia and decrease the likelihood of need for orchiectomy secondary to infarction. […] The two most important determinants of salvage rate of the testis include the degree of cord twisting and the time interval between the onset of symptoms and detorsion. […] The present study revealed that delayed treatment of TT was directly associated with testicular salvage ability. […] As the time from symptom onset to treatment extended, the rate of orchidectomy exhibited a noticeably upward trend. […] The orchidectomy rate was 5.9% in patients who underwent surgery within 6 h after onset of symptoms, while it rose to 82.1% in patients who underwent surgery at 24 h after onset of symptoms.

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

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

  The viability of the testicle in cases of torsion is difficult to predict; hence, emergent surgical treatment is indicated despite many patients presenting beyond the four- to eight-hour time frame. […] Reported testicular salvage rates are 90% to 100% if surgical exploration is performed within six hours of symptom onset, decrease to 50% if symptoms are present for more than 12 hours, and are typically less than 10% if symptom duration is 24 hours or more. […] Manual detorsion should not replace surgical exploration. […] The testes are typically detorsed from the medial to lateral side, turning the physician’s hands as if opening a book. […] Orchiectomy is performed if the affected testicle appears grossly necrotic or nonviable. […] 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.

• #40 Azthena logo with the word Azthena

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

  In most individuals suffering from testicular torsion, the testicle rotates between 90 and 100 degrees, and blood flow is subsequently compromised. Complete torsion is very rare and very quickly reduces the viability of the testes. […] 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. […] However, when blood flow has been cut off for longer than this, the risk of damage to the testicle increases and may ultimately result in a testicular loss period.

• #41 Analysis of factors associated with delayed diagnosis and treatment of testicular torsion in 1005 cases from Chongqing city, China: a cross-sectional study | Scientific Reports

  https://www.nature.com/articles/s41598-023-49820-9

  This study aimed to investigate the clinical and social factors of delayed treatment for testicular torsion (TT) and to explore the risk factors of testicular excision in China. […] Timely diagnosis and surgical intervention of TT are crucial to prevent testicular ischemia and decrease the likelihood of need for orchiectomy secondary to infarction. […] The two most important determinants of salvage rate of the testis include the degree of cord twisting and the time interval between the onset of symptoms and detorsion. […] The present study revealed that delayed treatment of TT was directly associated with testicular salvage ability. […] As the time from symptom onset to treatment extended, the rate of orchidectomy exhibited a noticeably upward trend. […] The orchidectomy rate was 5.9% in patients who underwent surgery within 6 h after onset of symptoms, while it rose to 82.1% in patients who underwent surgery at 24 h after onset of symptoms.

• #42 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. Prompt diagnosis and treatment of testicular torsion is essential for testicular viability. At surgical exploration, the spermatic cord is seen twisted a variable number of times around its longitudinal axis. […] There is scant data regarding the degree of twisting found at surgical exploration and its association with testis outcomes. […] The purpose of our study is to further explore how the degree of torsion factors into testicular outcome. It is hypothesized that the greater number of twists of the spermatic cord would offer more obstruction of the vasculature and thus a lower salvage rate based on immediate intraoperative findings (orchiectomy) along with delayed atrophy of the testicle at follow-up. […] A non-parametric Wilcoxon rank/Kruskal-Wallis analysis confirmed that non-salvageable testicles tended to have significantly higher degrees of twisting when compared to their viable counterparts.

• #43 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

  We were also able to determine the clinical significance of the degree of twisting (separate from the duration of pain as the degree of twist did not significantly contribute to derive a formula which combined both variables) in ultimate testis viability during episodes of testicular torsion in the pediatric population, despite a low sensitivity on ROC analysis. When there is greater than one twist (more than 360 degrees) seen in the spermatic cord at scrotal exploration, there is a higher risk of non-salvage for the testis based on our data. […] 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.

• #44 Analysis of factors associated with delayed diagnosis and treatment of testicular torsion in 1005 cases from Chongqing city, China: a cross-sectional study | Scientific Reports

  https://www.nature.com/articles/s41598-023-49820-9

  The results of the present study showed that the misdiagnosis rates in non-tertiary (primary and secondary) and tertiary hospitals were 37.8% and 11.2%, respectively, and the misdiagnosis rates among non-senior (primary and intermediate) grade and senior title doctors were 25.1% and 9.6%, respectively. […] The multivariate logistic regression analysis indicated that absent cremasteric reflex was a protective factor for delayed surgery for more than 6 h from onset of symptoms to surgery. […] A negative high riding testis was identified as a risk factor for delayed surgery for more than 6 h from the onset of symptoms to surgery, which is consistent with previously reported findings. […] The results of the multivariate logistic regression analysis in the present study demonstrated that the misdiagnosis, non-urologist first-consultant doctor, absent blood flow in DUS, non-manual detorsion, fever, and degree of cord twisting 180 were risk factors for orchidectomy. […] The current study presented fewer cases of torsional fever. […] Numerous studies have established a correlation between the degree of testicular twist and the risk of a non-salvageable testis.

• #45 Diagnosis of testicular torsion with preserved blood flow detected by color Doppler ultrasonography | Bulletin of the National Research Centre | Full Text

  https://bnrc.springeropen.com/articles/10.1186/s42269-023-01134-6

  Testicular torsion is a surgical emergency in which treatment should not be delayed because it can lead to testicular ischemia and atrophy. Immediate diagnosis of testicular torsion has therefore been associated with an increase in the rates of testicular salvage. Appropriate diagnosis of testicular torsion is predominantly based on findings of ultrasonography (US). Color Doppler ultrasonography (CDUS) is useful to diagnose testicular torsion by the findings of absent or decreased testicular blood flow. However, such accurate diagnosis is difficult when blood flow is preserved in the testis, as shown by CDUS. […] Testicular vascularity can be preserved in cases of partial or incomplete torsion, such as the spermatic cord twists less than 360 and/or for a short duration. If the degree of spermatic cord torsion is less than 360, venous outflow is obstructed when but arterial flow is preserved. If the degree of spermatic cord torsion is 360 or greater, arterial flow is disturbed, which could lead to testicular ischemia.

• #46 Diagnosis of testicular torsion with preserved blood flow detected by color Doppler ultrasonography | Bulletin of the National Research Centre | Full Text

  https://bnrc.springeropen.com/articles/10.1186/s42269-023-01134-6

  Degree of torsion was 180 in all cases with preserved testicular blood flow by CDUS, and in this study, duration of symptoms until surgery was shorter than that in cases with decreased blood flow. […] The presence of testicular blood flow by CDUS does not exclude testicular torsion. Such cases represent lesser-degree testicular torsion or of a short duration. If testicular blood flow is detected by CDUS, the presence of abnormal testicular findings by physical examination, including testicular swelling, testicular tenderness, abnormal testicular position and the absence of cremasteric reflex, is highly suspicious of testicular torsion. Moreover, a short duration of symptoms and normal scrotal findings may be useful for diagnosis of testicular torsion with normal testicular blood flow. When testicular blood flow is preserved by CDUS, testicular torsion should not be ruled out based on CDUS finding, but should be diagnosed with duration of symptom and findings in the testis and scrotum.

• #47 Diagnosis of testicular torsion with preserved blood flow detected by color Doppler ultrasonography | Bulletin of the National Research Centre | Full Text

  https://bnrc.springeropen.com/articles/10.1186/s42269-023-01134-6

  Degree of torsion was 180 in all cases with preserved testicular blood flow by CDUS, and in this study, duration of symptoms until surgery was shorter than that in cases with decreased blood flow. […] The presence of testicular blood flow by CDUS does not exclude testicular torsion. Such cases represent lesser-degree testicular torsion or of a short duration. If testicular blood flow is detected by CDUS, the presence of abnormal testicular findings by physical examination, including testicular swelling, testicular tenderness, abnormal testicular position and the absence of cremasteric reflex, is highly suspicious of testicular torsion. Moreover, a short duration of symptoms and normal scrotal findings may be useful for diagnosis of testicular torsion with normal testicular blood flow. When testicular blood flow is preserved by CDUS, testicular torsion should not be ruled out based on CDUS finding, but should be diagnosed with duration of symptom and findings in the testis and scrotum.

• #48 Testicular Torsion in the Emergency Room: A Review of Detection and Ma | OAEM

  https://www.dovepress.com/testicular-torsion-in-the-emergency-room-a-review-of-detection-and-man-peer-reviewed-fulltext-article-OAEM

  Testicular torsion is an urological emergency necessitating emergent intervention. It occurs when the testicle rotates around its spermatic cord leading to impaired blood supply and possible permanent ischemic testicular damage. The severity of ischemia varies and is dependent on the time period of torsion as well as the extent of rotation of the cord. […] The early recognition of testicular torsion has been associated with an increase in the rates of testicular salvage and the prevention of complications such as testicular infarction and infertility. […] In general, the underlying etiology of testicular torsion is not easily identifiable. However, there are a number of factors including genetic factors, environmental factors, preceding trauma and the clapper-bell deformity that may predispose a patient to testicular torsion.

• #49 Testicular torsion: A case report | Cirugía y Cirujanos (English Edition)

  https://www.elsevier.es/en-revista-cirugia-cirujanos-english-edition–237-articulo-testicular-torsion-a-case-report-S2444050717300773

  The acute scrotum is an emergency. Testicular torsion represents approximately 25% of the causes. The annual incidence of testicular torsion is approximately 1/4000 persons under 25 years, with highest prevalence between 12 and 18 years old. It usually occurs without apparent cause, but it has been associated with anatomical, traumatic, and environmental factors, among others. […] In general there is no apparent causes, but several factors relating to the deformity have been described in bell clapper testis, where there is an abnormal adherence of the tunica vaginalis to the testicle, and this results in an increase in the mobility of the testicle inside the tunica vaginalis. Other associated factors are: the increase in testicular volume, testicular tumours, testicle with a horizontal position, a history of cryptorchidism, spermatic cord with a long intrascrotal section, high or proximal insertion of the tunica vaginalis to the spermatic cord, trauma and recent exercise. Environmental factors, such as low temperatures, have also been associated with testicular torsion. […] Testicular torsion should always be considered as one of the main causes of acute scrotal pain. Delayed diagnosis should be avoided and the patient should always be referred for a further level of treatment since its delay is directly related to the percentage of testicular salvage or loss.

• #50 03.03 Nursing Care and Pathophysiology for Testicular Torsion | Free NURSING.com Courses

  https://nursing.com/lesson/03-03-nursing-care-and-pathophysiology-for-testicular-torsion

  Testicular torsion is when the spermatic cord is twisted and leads to loss of blood supply to the following testicle and if untreated, can lead to loss of the affected testicle. […] This occurs when there is a twist of the spermatic cord. The spermatic cord is what suspends the testicle in the scrotum. This also is where the testicular artery and vein are. Twisting of this will reduce or stop blood flow to the testicle. […] Testicle rotates inside scrotum. Twists the arteries and veins in spermatic cord. Interrupts blood flow to testis. Causes strangulation. […] Results in vascular engorgement, ischemia, and scrotal swelling. […] Without treatment, leads to infarction of testis due to lack of blood supply. […] Testicular torsion can be caused by abnormalities inside or outside the membrane that covers the testicle.

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

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

  Testicular torsion occurs when a testicle rotates, twisting the spermatic cord that brings blood to the scrotum. The reduced blood flow causes sudden and often severe pain and swelling. […] 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. […] It’s not clear why testicular torsion occurs. Most males who get testicular torsion have an inherited trait that allows the testicle to rotate freely inside the scrotum. This inherited condition often affects both testicles. But not every male with the trait will have testicular torsion. […] Testicular torsion often occurs several hours after vigorous activity, after a minor injury to the testicles or while sleeping. Cold temperature or rapid growth of the testicle during puberty also might play a role.

• #52 Testicular Torsion: Definition, Symptoms, and Treatment

  https://www.healthline.com/health/testicular-torsion

  The most common cause of an emergency related to the male genitourinary tract is a highly painful one called testicular torsion. […] During a torsion of the testes, this cord twists. As a result, blood flow is affected and the tissues in the testicle can start to die. […] Those who experience torsion sometimes have weaker connective tissue in the scrotum. […] If you have a bell clapper deformity, your testicles can move more freely in the scrotum. This movement increases the risk of the spermatic cord becoming twisted. This deformity accounts for 90 percent of testicular torsion cases. […] Testicular torsion can run in families, affecting multiple generations as well as siblings. […] The condition can occur at any time, even before birth. Testicular torsion can occur when you’re sleeping or engaging in physical activity.

• #53 Testicular Torsion: Definition, Symptoms, and Treatment

  https://www.healthline.com/health/testicular-torsion

  Rapid growth of the testicles during puberty may also cause the condition. […] Torsion of the testes is a medical emergency, but many adolescents are hesitant to say that they’re hurting or seek treatment right away. […] It’s possible for some to experience what’s known as intermittent torsion. This causes a testicle to twist and untwist. […] Surgery is performed as quickly as possible to restore blood flow to the testicles. If blood flow is cut off for more than six hours, testicular tissue can die. […] If left untreated for more than several hours, the testicle may become severely damaged, requiring its removal. The testicle can usually be saved if it’s treated within a four-to-six-hour window. […] After a period of 12 hours, there’s a 50 percent chance of saving the testicle. After 24 hours, the chances of saving the testicle drop to 10 percent. […] Testicular torsion surgery is highly effective if the condition is caught early.

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

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

  Testicular torsion occurs when a testicle rotates, twisting the spermatic cord that brings blood to the scrotum. The reduced blood flow causes sudden and often severe pain and swelling. […] 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. […] It’s not clear why testicular torsion occurs. Most males who get testicular torsion have an inherited trait that allows the testicle to rotate freely inside the scrotum. This inherited condition often affects both testicles. But not every male with the trait will have testicular torsion. […] Testicular torsion often occurs several hours after vigorous activity, after a minor injury to the testicles or while sleeping. Cold temperature or rapid growth of the testicle during puberty also might play a role.

• #55 Testicular torsion: A case report | Cirugía y Cirujanos (English Edition)

  https://www.elsevier.es/en-revista-cirugia-cirujanos-english-edition–237-articulo-testicular-torsion-a-case-report-S2444050717300773

  The acute scrotum is an emergency. Testicular torsion represents approximately 25% of the causes. The annual incidence of testicular torsion is approximately 1/4000 persons under 25 years, with highest prevalence between 12 and 18 years old. It usually occurs without apparent cause, but it has been associated with anatomical, traumatic, and environmental factors, among others. […] In general there is no apparent causes, but several factors relating to the deformity have been described in bell clapper testis, where there is an abnormal adherence of the tunica vaginalis to the testicle, and this results in an increase in the mobility of the testicle inside the tunica vaginalis. Other associated factors are: the increase in testicular volume, testicular tumours, testicle with a horizontal position, a history of cryptorchidism, spermatic cord with a long intrascrotal section, high or proximal insertion of the tunica vaginalis to the spermatic cord, trauma and recent exercise. Environmental factors, such as low temperatures, have also been associated with testicular torsion. […] Testicular torsion should always be considered as one of the main causes of acute scrotal pain. Delayed diagnosis should be avoided and the patient should always be referred for a further level of treatment since its delay is directly related to the percentage of testicular salvage or loss.

• #56 Testicular torsion: Causes, symptoms, and treatment

  https://www.medicalnewstoday.com/articles/190514

  Factors that increase the chances of testicular torsion include: Age: Testicular torsion is most common in males below the age of 25 years and often affects adolescent males between aged 12-16 years. […] If the torsion occurs once and resolves without treatment, it is likely to happen again in either testicle unless surgery can correct the underlying problem. […] Many health experts call torsions winter syndrome because they commonly occur during cold weather. […] The only way to prevent testicular torsion with this trait is through surgery to attach both testicles to the inside of the scrotum so that they cannot rotate freely. […] Testicular torsion is a condition where an individual’s testicle rotates around the spermatic cord, blocking blood flow to the area. […] Testicular torsion is an emergency that requires immediate medical attention, ideally within 6 hours.

• #57 Testicular torsion: Causes, symptoms, and treatment

  https://www.medicalnewstoday.com/articles/190514

  Testicular torsion is when a testicle rotates on this cord. […] Testicular torsion is a medical emergency it occurs when blood flow to the testicle stops, causing sudden and often severe pain and swelling. […] The resulting loss of blood flow can lead to the death of the testicle and surrounding tissues. […] Testicular torsion occurs if the testicle rotates on the cord that runs upward from the testicle into the abdomen. […] The rotation twists the spermatic cord and reduces blood flow. […] People who experience testicular torsion may have an inherited trait that allows one or both testicles to rotate freely inside the scrotum. […] Testicular torsion can occur at any time, including standing, sleeping, exercising, or sitting, and with no apparent trigger in those who are susceptible.

• #58 Testicular torsion-detorsion syndrome | Radiology Reference Article | Radiopaedia.org

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

  Testicular torsion-detorsion syndrome or intermittent testicular torsion refers to acute and periodic testicular pain due to limited blood flow, integrated with asymptomatic periods. […] In neonates, the most common form of torsion is extravaginal or supravaginal where the whole content of the hemiscrotum twists around the spermatic cord at the level of the external inguinal ring. […] In young adults or adolescents, the more expected torsion is intravaginal. The most common underlying abnormality is the so-called bell clapper deformity. This deformity is noted in 5-16% of males and is bilateral in 66-100% of cases. […] Given that torsion-detorsion syndrome ultimately will progress to acute testicular infarction, an elective orchiopexy in smaller series has shown an excellent outcome.

• #59 Testicular Torsion: Definition, Symptoms, and Treatment

  https://www.healthline.com/health/testicular-torsion

  Rapid growth of the testicles during puberty may also cause the condition. […] Torsion of the testes is a medical emergency, but many adolescents are hesitant to say that they’re hurting or seek treatment right away. […] It’s possible for some to experience what’s known as intermittent torsion. This causes a testicle to twist and untwist. […] Surgery is performed as quickly as possible to restore blood flow to the testicles. If blood flow is cut off for more than six hours, testicular tissue can die. […] If left untreated for more than several hours, the testicle may become severely damaged, requiring its removal. The testicle can usually be saved if it’s treated within a four-to-six-hour window. […] After a period of 12 hours, there’s a 50 percent chance of saving the testicle. After 24 hours, the chances of saving the testicle drop to 10 percent. […] Testicular torsion surgery is highly effective if the condition is caught early.

• #60 Testicular torsion-detorsion syndrome | Radiology Reference Article | Radiopaedia.org

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

  Testicular torsion-detorsion syndrome or intermittent testicular torsion refers to acute and periodic testicular pain due to limited blood flow, integrated with asymptomatic periods. […] In neonates, the most common form of torsion is extravaginal or supravaginal where the whole content of the hemiscrotum twists around the spermatic cord at the level of the external inguinal ring. […] In young adults or adolescents, the more expected torsion is intravaginal. The most common underlying abnormality is the so-called bell clapper deformity. This deformity is noted in 5-16% of males and is bilateral in 66-100% of cases. […] Given that torsion-detorsion syndrome ultimately will progress to acute testicular infarction, an elective orchiopexy in smaller series has shown an excellent outcome.

• #61 Testicular Torsion: Causes, Symptoms, and Treatment

  https://patient.info/mens-health/scrotal-lumps-pain-and-swelling/torsion-of-the-testis

  The sooner the operation is done, the better the outlook to save your testis. Ideally, the operation should be done within 6-8 hours of symptoms starting. […] Some boys and men have warning pains in a testicle (testis) every now and then, before a full-blown twisting (torsion). These occur suddenly, last for a few minutes, then ease just as suddenly. […] Both how badly the testis has twisted and how long it stays twisted for are important in the outcome. If correcting surgery happens within six hours of torsion, 9 or 10 out of 10 testes will be saved on average. If surgery is delayed until between 12 hours and 24 hours from the start of symptoms then only one testis is saved out of 10.

• #62 Testicular Torsion: Causes, Symptoms, and Treatment

  https://patient.info/mens-health/scrotal-lumps-pain-and-swelling/torsion-of-the-testis

  The sooner the operation is done, the better the outlook to save your testis. Ideally, the operation should be done within 6-8 hours of symptoms starting. […] Some boys and men have warning pains in a testicle (testis) every now and then, before a full-blown twisting (torsion). These occur suddenly, last for a few minutes, then ease just as suddenly. […] Both how badly the testis has twisted and how long it stays twisted for are important in the outcome. If correcting surgery happens within six hours of torsion, 9 or 10 out of 10 testes will be saved on average. If surgery is delayed until between 12 hours and 24 hours from the start of symptoms then only one testis is saved out of 10.

• #63 Testicular torsion-detorsion syndrome | Radiology Reference Article | Radiopaedia.org

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

  Testicular torsion-detorsion syndrome or intermittent testicular torsion refers to acute and periodic testicular pain due to limited blood flow, integrated with asymptomatic periods. […] In neonates, the most common form of torsion is extravaginal or supravaginal where the whole content of the hemiscrotum twists around the spermatic cord at the level of the external inguinal ring. […] In young adults or adolescents, the more expected torsion is intravaginal. The most common underlying abnormality is the so-called bell clapper deformity. This deformity is noted in 5-16% of males and is bilateral in 66-100% of cases. […] Given that torsion-detorsion syndrome ultimately will progress to acute testicular infarction, an elective orchiopexy in smaller series has shown an excellent outcome.

• #64 Testicular Torsion Care | Dayton Children’s Hospital

  https://www.childrensdayton.org/testicular-torsion

  Sometimes, the spermatic cord can become twisted and then untwist itself without treatment. This is called torsion and detorsion, and it can make testicular torsion more likely to happen again in the future. […] Saving a testicle becomes harder the longer the spermatic cord stays twisted. The stage of twisting (whether it’s one full circle or more) tells you how quickly the testicle will become harmed. […] Testicular torsion almost always needs surgery to fix. In rare cases, the doctor might be able to untwist the spermatic cord by pushing on the scrotum, but most of the time surgery will still be needed to attach both testicles to the scrotum to stop torsion from occurring in the future. […] If a torsion goes on too long, doctors won’t be able to save the affected testicle and it will be removed in a surgery called an orchiectomy.

• #65 Testicular torsion-detorsion syndrome | Radiology Reference Article | Radiopaedia.org

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

  Testicular torsion-detorsion syndrome or intermittent testicular torsion refers to acute and periodic testicular pain due to limited blood flow, integrated with asymptomatic periods. […] In neonates, the most common form of torsion is extravaginal or supravaginal where the whole content of the hemiscrotum twists around the spermatic cord at the level of the external inguinal ring. […] In young adults or adolescents, the more expected torsion is intravaginal. The most common underlying abnormality is the so-called bell clapper deformity. This deformity is noted in 5-16% of males and is bilateral in 66-100% of cases. […] Given that torsion-detorsion syndrome ultimately will progress to acute testicular infarction, an elective orchiopexy in smaller series has shown an excellent outcome.

• #66 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. […] Testicular torsion is a clinical diagnosis, and patients typically present with severe acute unilateral scrotal pain, nausea, and vomiting. […] Whether testicular torsion is intravaginal or extravaginal, twisting of the spermatic cord initially increases venous pressure and congestion, with subsequent decrease in arterial blood flow and ischemia. […] Prompt restoration of blood flow to the ischemic testicle is critical in cases of testicular torsion, and prompt referral to a urologist is recommended. […] There is typically a four- to eight-hour window before significant ischemic damage occurs, manifested by morphologic changes in testicular histopathology and deleterious effects on spermatogenesis.

• #67 Testicular torsion: MedlinePlus Medical EncyclopediaLock

  https://medlineplus.gov/ency/article/000517.htm

  The testicle may continue to function properly if the condition is found early and treated right away. The chances that the testicle will need to be removed increase if blood flow is reduced for more than 6 hours. However, sometimes it may lose its ability to function even if torsion has lasted fewer than 6 hours. […] The testicle may shrink if blood supply is cut off for an extended time. It may need to be surgically removed. Shrinkage of the testicle may occur days to months after the torsion has been corrected. Severe infection of the testicle and scrotum is also possible if the blood flow is limited for a long period.

• #68 Testicular torsion Information | Mount Sinai – New York

  https://www.mountsinai.org/health-library/diseases-conditions/testicular-torsion

  The testicle may continue to function properly if the condition is found early and treated right away. The chances that the testicle will need to be removed increase if blood flow is reduced for more than 6 hours. However, sometimes it may lose its ability to function even if torsion has lasted fewer than 6 hours. […] The testicle may shrink if blood supply is cut off for an extended time. It may need to be surgically removed. Shrinkage of the testicle may occur days to months after the torsion has been corrected. Severe infection of the testicle and scrotum is also possible if the blood flow is limited for a long period.

• #69 Testicular Torsion – Men’s Health Issues – MSD Manual Consumer Version

  https://www.msdmanuals.com/home/men-s-health-issues/penile-and-testicular-disorders/testicular-torsion

  Testicular torsion is the twisting of a testis on its spermatic cord so that the blood supply to the testis is blocked. […] Abnormal development of the spermatic cord or the membrane covering the testis makes testicular torsion possible. […] With torsion, the testis usually dies within 6 to 12 hours after the blood supply is cut off unless the torsion is treated.

• #70 Testicular Torsion: Diagnosis and Treatment

  https://www.urology-textbook.com/testicular-torsion.html

  Testicular torsion is a mostly spontaneous torsion of the testicle around the spermatic cord with consecutive ischemia. […] Abnormal mobility of the testicle causes testicular torsion. Cremasteric contraction causes a rotational force to the testes and can induce testicular torsion, as also manipulation or testicular trauma may trigger a torsion. […] The torsion of the testis leads to impaired venous drainage and hemorrhagic necrosis of the testicular tissue. The testicular tissue is irreversibly damaged after eight hours of complete torsion. […] Subfertility may develop after testicular torsion; the prevalence and mechanisms are unclear and controversial. Possible mechanisms are reflectory sympathetic vasocontriction with subsequent ischemia and damage to the blood-testis barrier with formation of anti-sperm antibodies. […] Untreated testicular torsion leads to hemorrhagic necrosis of the testis since the torsion of the spermatic cord first compresses the venous supply.

• #71 Testicular Torsion in the Emergency Room: A Review of Detection and Ma | OAEM

  https://www.dovepress.com/testicular-torsion-in-the-emergency-room-a-review-of-detection-and-man-peer-reviewed-fulltext-article-OAEM

  A history of more than 10 hours between onset of symptoms and surgery is a very strong indicator of testicular non-viability with an associated sensitivity and specificity of 62% and 100%, respectively. […] Despite prompt diagnosis and orchidopexy, infertility remains a major issue after the treatment of testicular torsion.

• #72 Testicular Torsion in the Emergency Room: A Review of Detection and Ma | OAEM

  https://www.dovepress.com/testicular-torsion-in-the-emergency-room-a-review-of-detection-and-man-peer-reviewed-fulltext-article-OAEM

  A history of more than 10 hours between onset of symptoms and surgery is a very strong indicator of testicular non-viability with an associated sensitivity and specificity of 62% and 100%, respectively. […] Despite prompt diagnosis and orchidopexy, infertility remains a major issue after the treatment of testicular torsion.

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