Testicular torsion and the acute scrotum: current emergency management

Ta, Anthony; D’Arcy, Frank; Hoag, Nathan; D’Arcy, John; Lawrentschuk, Nathan

doi:10.1097/mej.0000000000000303

Cited by 41 publications

(27 citation statements)

References 44 publications

(65 reference statements)

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“…Similarly, Doppler ultrasound also has its advantages of excellent imaging of anatomical details and perfusion, high availability, short duration, and low costs. 11 However, there are two key limitations of Doppler in the diagnosis of testicular torsion especially in infants and children, that is, the high false-negative rate and high operator dependency, 12 , 13 especially in emergency settings. Also, our ultrasound specificity was only 71.4%.…”

Section: Discussionmentioning

confidence: 99%

A Minimally Invasive Method in Diagnosing Testicular Torsion: The Initial Experience of Scrotoscope

Wang

et al. 2016

Journal of Endourology

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Purpose: To introduce scrotoscopy in the diagnosis of testicular torsion and evaluate its value in clinical application.Patients and Methods: From February 2010 to June 2013, 14 patients, aged 12 to 24 years, were included into this study due to acute onset of scrotal pain. On Doppler ultrasound imaging, the blood flow decreased in seven cases (including two “no flow” cases) and remained normal in the other seven. Following anesthesia, a 10F pediatric cystoscope employed as scrotoscope was inserted into the cavity of tunica vaginalis of the testis with continued saline washing to exam the testis and epididymis.Results: The scrotoscope had a diagnostic accuracy of 100% (100% specificity and 100% sensitivity), and the color Doppler ultrasound had 77.8% specificity. Five cases were diagnosed with testicular torsion, among which four were corrected and one underwent orchiectomy. No complications were observed in these patients. Nine patients with epididymitis were given oral antibiotics, and the blood flow of the testis was normal in the testis-preserving patient.Conclusions: Our study showed that scrotoscopy could serve as a minimally invasive, safe, and effective approach in the early diagnosis of testicular torsion.

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Section: Discussionmentioning

confidence: 99%

A Minimally Invasive Method in Diagnosing Testicular Torsion: The Initial Experience of Scrotoscope

Wang

et al. 2016

Journal of Endourology

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“…In two separate studies, Scarabelli et al and The 720-degree rotation is called complete spermatic cord torsion, and an experimental animal study has shown that this degree of torsion causes irreversible ischaemic damage and gonadal loss in the testis within 2 hr (Asgari et al, 2006). In some series, it was reported that testicular torsions on the left side were more common than the TA B L E 2 Comparison of MDA, SOD and CAT values of the groups in pairs, and Johnsen Testicular Biopsy Score (JTBS) values of groups in pairs F I G U R E 1 a. Spermatids (↑) and spermatozoa (▲) in testis of control group, b. a small number of ghost germinal epithelial cells were observed in the left testis tubule lumen of the torsion/ detorsion group (▲), and c. spermatids (↑) and spermatozoa (▲) in testis of Group 3 right (Ta et al, 2016). In this study, we preferred 720-degree torsion and 2-hr reperfusion to the left testis.…”

Section: Discussionmentioning

confidence: 99%

Effects of myricetin on testicular torsion‐detorsion injury in rats

et al. 2020

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Testicular torsion is an emergency that causes the reduction of blood flow in the testis and surrounding structures in neonates, children and adolescents owing to the rotation of the spermatic cord around itself (Yilmaz et al., 2015; Lee et al., 2012). Early diagnosis and surgical management are required to prevent infertility and subfertility (Akgur et al., 1993). The incidence in men under 25 years is 1/4,000 (Mansour et al., 2019). Of the patients, 61% are under 21 years of age and have a bimodal age distribution. It peaks in two separate periods: in neonatal patients and those approximately 13 years of age (Kapoor, 2008; Gomes Dde et al., 2015). Interestingly, the frequency of testicular torsion was associated with environmental factors. In winter, especially in December, the frequency of testicular torsion increased (14%) (Lyronis et al., 2009). Testicular torsion should be diagnosed within the first 4-6 hr. Especially if there is complete spermatic cord torsion (i.e. 720-degree rotation), as it causes irreversible ischaemic damage and gonad loss in the testis (Asgari et al., 2006). Despite successful surgical intervention, 40%-60% of testicular atrophy may develop into infertility in the following years (Yildirim et al., 2018). The main pathophysiology of testicular torsion is, after ischaemic injury induced by a torsioned spermatic cord, surgical detorsion causes reperfusion injury due to free oxygen radicals (Anim et al., 2005). Ischaemia-reperfusion (I/R) damage occurs because of the stimulation of an intracellular cascade containing activation of

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“…On physical examination, a high-riding testis, an abnormally oriented testis, and absent cremasteric reflexes should raise suspicion of TT. The cremasteric reflex is elicited when the medial aspect of the thigh is stroked, leading to the contraction of the cremasteric muscle and thus resulting in the elevation of the testis [6]. In TAT, the necrotic appendix can be observed through the scrotum, giving rise to the blue dot sign.…”

Section: Discussionmentioning

confidence: 99%

“…Laboratory investigations can be performed to rule out other possible etiologies. Nevertheless, clinicians must not depend exclusively on clinical findings since they are not absolute in yielding a definitive diagnosis, and misdiagnosis of TT can lead to exceedingly adverse disease outcomes such as gangrene of the testis [6][7][8]. Murphy et al reported three cases of patients with a normal cremasteric reflex requiring orchidectomy [7].…”

Section: Discussionmentioning

confidence: 99%

The Spectrum of Testicular Pathologies Upon Scrotal Exploration for Acute Scrotum: A Retrospective Analysis

Syed¹,

Faqeeh²,

Othman³

et al. 2020

Cureus

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Background The term acute scrotum encompasses a plethora of testicular pathologies that are detrimental to the survival and sustenance of testes. The aim of the present study is to determine the spectrum of these testicular pathologies upon scrotal exploration performed in the aftermath of acute scrotal pain in the pediatric population. Methods This multicenter retrospective cross-sectional study was conducted at the department of pediatric surgery at two hospitals. During the study period, the clinical characteristics of the 76 patients that underwent scrotal exploration for acute scrotum were assessed. These included age, duration of symptoms on presentation, and identification of the etiology underlying scrotal pain. The data obtained was eventually analyzed using the Statistical Package for the Social Sciences (SPSS) 23.0 software (IBM Corp., Armonk, NY). Results A total of 76 scrotal exploration procedures were performed. The involvement of the left side of the scrotum was more common than the right side. Most of the patients who presented were older than five years of age. A majority of the patients presented after 24 hours of the commencement of their symptoms. Of the included participants, 36 patients (47.47%) were found to have an underlying torsion of appendix testes that was appropriately managed. Testicular torsion was observed in 15 patients, out of which eight viable testes were salvaged with a subsequent orchidopexy while seven torsions required orchiectomy owing to their nonviability. Other findings included epididymo-orchitis and infected hydrocele. A total of 19 testes appeared completely normal upon scrotal exploration. Conclusion Scrotal exploration should be considered as part of the medical and surgical workup and in the management of acute scrotum, as it divulges the specific underlying testicular pathology. Prompt scrotal exploration can aid in ascertaining the underlying etiology and is, therefore, pivotal in the apt management of the underlying pathology.

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Testicular torsion and the acute scrotum: current emergency management

Cited by 41 publications

References 44 publications

A Minimally Invasive Method in Diagnosing Testicular Torsion: The Initial Experience of Scrotoscope

A Minimally Invasive Method in Diagnosing Testicular Torsion: The Initial Experience of Scrotoscope

Effects of myricetin on testicular torsion‐detorsion injury in rats

The Spectrum of Testicular Pathologies Upon Scrotal Exploration for Acute Scrotum: A Retrospective Analysis

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