Torsion of the Spermatic Cord

Ransler, Charles W.; Allen, Terry D.

doi:10.1016/s0094-0143(21)01327-6

Cited by 55 publications

(8 citation statements)

References 19 publications

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“…In this study, we found that the accuracy rates for US in the determination of the directionality of testicular rotation and the degree of spermatic cord twist were 78.6% and 36.4%, respectively, in our cohort. A previous report recommended twisting the testis toward the outer direction when performing manual reduction because the directionality of testicular rotation is usually toward the inner direction in pediatric patients with testicular torsion; however, according to our results, 50.0% of the testicular torsion cases had an outer direction of testicular rotation. Therefore, we believe that pediatric surgeons and urologists should use caution in the direction of rotation when performing manual reduction.…”

Section: Discussioncontrasting

confidence: 56%

“…Although there was no association between testicular loss and the duration of symptoms or the degree of spermatic cord twist, prompt surgical treatment is reported to be critical for the survival of testicles . This result may also have been due to the small number of cases.…”

Section: Discussionmentioning

confidence: 94%

“…There are various reports on whether testicular torsion is more likely to occur on the left or right . Skoglund et al and Williamson reported that testicular torsion tended to occur on the left side because the left spermatic cord is longer than the right.…”

Section: Discussionmentioning

confidence: 99%

“…There are various reports on whether testicular torsion is more likely to occur on the left or right. 2,4,16,26 Skoglund et al 26 and Williamson 4 reported that testicular torsion tended to occur on the left side because the left spermatic cord is longer than the right. There was an even higher occurrence on the left side in our small cohort than that shown in previous reports.…”

Section: Discussionmentioning

confidence: 99%

“…Salvage rates are less than 10% when testicular blood flow is restored after 24 hours . Although surgical intervention for definitive treatment is needed as soon as possible, attempts at manual reduction of torsion could be recommended as temporizing measures . Manual reduction requires the pediatric surgeon or urologist to perform detorsion of the testis in the opposite direction of the testicular twist.…”

mentioning

confidence: 99%

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Diagnostic Accuracy of Ultrasound for the Directionality of Testicular Rotation and the Degree of Spermatic Cord Twist in Pediatric Patients With Testicular Torsion

Hosokawa

Takahashi

Tanami

et al. 2019

J of Ultrasound Medicine

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Objectives-To evaluate the diagnostic accuracy of ultrasound (US) to diagnose the directionality of testicular rotation and the degree of spermatic cord twist in pediatric patients with testicular torsion.Methods-A retrospective review of 14 pediatric patients with testicular torsion was conducted. The directionality of testicular rotation was classified as an inner or outer direction (inner, counterclockwise in the left testis [viewed from below] and clockwise in the right testis; and outer, counterclockwise in the right testis and clockwise in the left testis). The Clopper-Pearson method and the Fisher exact, Mann-Whitney U, and Wilcoxon signed rank sum tests were used for the statistical analyses.Results-The diagnostic accuracy of US in the directionality of testicular rotation and the degree of spermatic cord twist were 78.6% (11 of 14; 95% confidence interval, 49.2%-95.3%) and 36.4% (4 of 11; 95% confidence interval, 10.9%-69.2%), respectively. Outer rotation was seen in 50.0% of the cases. The directionality of testicular rotation and the degree of spermatic cord twist as determined by US were not significantly different between the patients with salvaged testis and those with testicular loss (inner/outer direction, 4/2 versus 4/4; P = .627; mean twist AE SD, 330.0 AE 73.5 versus 337.5 AE 115.4 ; P > .999). There was no significant difference in the degree of spermatic cord twist determined by US and surgical results (343.0 AE 97.1 versus 458.2 AE 168.2 ; P = .063). Conclusions-The accuracy of US in determining the directionality of testicular rotation was relatively high in our small cohort. This information may be useful for pediatric surgeons and urologists when performing early manual reduction for testicular torsion.

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Section: Discussioncontrasting

confidence: 56%

Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Diagnostic Accuracy of Ultrasound for the Directionality of Testicular Rotation and the Degree of Spermatic Cord Twist in Pediatric Patients With Testicular Torsion

Hosokawa

Takahashi

Tanami

et al. 2019

J of Ultrasound Medicine

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The Diagnosis of Testicular Torsion

Haynes¹

1983

JAMA

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CORRESPONDENCE in homozygous sickle cell disease (SS) and 5.5 percent in SC/S-/3-thalassemia disease. The numbers of patients were 26 and 19, respectively. The difference in frequency between the two groups is not statistically significant (P>0.05). Yet the authors state that patients with Hb SC and Hb S-fl-thalassemia only should arrange in advance for inflight oxygen. They add: "We believe that adult patients with Hb SS do not need supplemental oxygen unless they are among the 6 percent of adult patients with Hb SS and intact spleens." Admittedly, there are fewer instances of splenic crises in SS disease (4.3 percent as compared with 8 percent in other forms), but it is not splenic crises only that we need to or can prevent by supplemental oxygen. The 6.5 percent of patients with Hb SS who do suffer vasoocclusive crises could benefit from inflight oxygen. The authors also found that whereas 42.9 percent of SS patients in Reno (elevation 4,400 ft) suffered vasoocclusive crises, only 31 percent of SS patients in Lake Tahoe (elevation 6,320 ft) had similar complications. This difference is significant (P<0.05). Watson-Williams also noted this in his critique of the paper,2 but neither he nor the original authors could provide an explanation for this seeming contradiction. In fact, there is no contradiction. Among other things, the sickling process of deoxylfib S is allosterically modified by pH and 2,3-diphosphoglycerate (2,3-DPG). Lowering the pH hastens sickling by decreasing the oxygen affinity of Hb S via the Bohr effect. In contrast, 2,3-DPG has no independent effect on the polymerization of Hb S. Instead it alters pH, which in turn enhances polymerization.3 It follows, therefore, that if the pH effect of 2,3-DPG is annulled by respiratory alkalosis, which occurs to a greater degree at 6,300 ft than 4,400 ft, it cannot influence polymerization of Hb S. While this phenomenon cannot adequately explain the reduced frequency of crises in patients from Denver when they are exposed to high altitudes,4 a comparison of the two studies done so far on the subject" 4 cannot be made since one recorded the frequency of vasoocclusive events' and the other recorded the number of patients who developed similar symptoms.4 In any event, this is one of the more intriguing findings in Claster and associates' study and deserves future investigation.

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Acute Experimental Testicular Torsion: No Effect on the Contralateral Testis

Turner

1985

Journal of Andrology

103

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Other investigators have shown that chronic unilateral testicular torsion produces negative effects on the contralateral testis in experimental animals. In the present study, bilateral testicular weight and histology, and concentrations and motility of spermatozoa from the cauda epididymidis were studied after 0 to 4 hours of acute unilateral testicular torsion in the rat. The obstruction of blood flow by torsion was documented, as well as the presence or absence of return blood flow after the relief of torsion. The above mentioned parameters of testicular function were studied at 7, 30, and 60 days after relief of torsion. Ipsilateral testis weights and epididymal sperm concentrations and motility were significantly reduced by 1, 2, and 4 hours of torsion. The histology of torsioned testes was also severely altered, and no seminiferous epithelial repair was evident 60 days after torsion. Contralateral testicles were not affected by ipsilateral torsion of 1, 2, or 4 hours duration, despite the fact that the ipsilateral testis function was completely compromised by 2 and 4 hours of torsion. These results indicate that there would be no clinical benefit in removing the acutely torsioned testis of Sprague–Dawley rats since it poses no threat to the contralateral testis.

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Torsion of the Spermatic Cord

Cited by 55 publications

References 19 publications

Diagnostic Accuracy of Ultrasound for the Directionality of Testicular Rotation and the Degree of Spermatic Cord Twist in Pediatric Patients With Testicular Torsion

Diagnostic Accuracy of Ultrasound for the Directionality of Testicular Rotation and the Degree of Spermatic Cord Twist in Pediatric Patients With Testicular Torsion

The Diagnosis of Testicular Torsion

Acute Experimental Testicular Torsion: No Effect on the Contralateral Testis

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