Torsion of spermatic cord

Evaluation of Testicular Viability by Power Doppler Ultrasonography in Experimentally Induced Acute Testicular Torsion

“…Testis size increases in cases of acute torsion due to venous congestion and the testis may then shrink and atrophy in parallel with the progression of necrosis. 4 In the present study, torsed testes sizes increased in viable testes, whereas 3 nonviable testes were of the same size as contralateral testes, which suggested that atrophication had started. On the other hand, 2 viable testes showed a minimal increase in size probably due to a low level of torsion and a partially patent venous flow.…”

“…The normal testis is anchored posterolaterally in the scrotal sac and is fixed in place. 4,6 Torsion does not in general instantaneously cut off testis blood flow, when a testis first twist on the spermatic cord venous drainage is compromised. This leads to venous congestion, which progresses to arterial occlusion and eventually testicular ischemia.…”

“…Moreover, testicular viability determines ischemic testes salvage rates, which are inversely related to the duration of ischemia. 4,5 A knowledge of testicular viability is important when considering the surgical management of testicular torsion, ie, when deciding upon emergency surgical detorsion with orchiopexy or orchiectomy. However, there are no established physical or laboratory tests that allow testicular viability to be determined.…”

Infrequently Performed Studies in Nuclear Medicine: Part 2

“…Emergency surgery is required to untwist the testicle to prevent necrosis; the salvage rate tends to reflect the time passed between onset of the event and the surgical detorsion. In one study (13), the salvage rate was 100% when surgery occurred within 6 h, 70% for surgery between 6 and 12 h, and only 20% when surgery occurred more than 12 h after onset of symptoms. Consequently, a request for a testicular scan in the setting of acute scrotal pain must be treated as an emergency.…”

Can ultrasound help to manage patients with scrotal trauma?

“…Urgent surgical intervention is required as the opportunity for successful testicular salvage decreases rapidly with time and orchidectomy is usually required if surgery is delayed by more than 12-24 hours. 20 Spermatic cord torsion is more common in patients with the 'bell-clapper' deformity where there is deficient attachment of the testis to the scrotal wall, allowing abnormal mobility of the testis within the scrotum. In the early stages following traumatic torsion, the grey scale appearances of the testis will often be normal before irreversible changes of testicular infarction and necrosis occur.…”