Torsion of the Testicle

Mellick, Larry B.

doi:10.1097/pec.0b013e31823f5ed9

Cited by 64 publications

(28 citation statements)

References 60 publications

(89 reference statements)

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“…The most common symptoms in TT are swelling/erythema, nausea and vomiting. Incidence of nausea and vomiting in our study was 48%, and in Mellick ( 13 ) it was 32%. The incidence of TT is more common in left side, as it was 74% in our patients, and 63% in Boettcher et al ( 12 ) study.…”

Section: Discussionsupporting

confidence: 41%

“…Degree of torsion can be one of predictors in TT. Cimador et al ( 10 ), and Mellick ( 13 ) found that there is no significant difference in TT with rotation degree of 360 to those with more than 360 degree. In our patients series orchidopexy was performed in 20 cases which had more than 360 (360 - 540) degree and of which 16 were salvaged.…”

Section: Discussionmentioning

confidence: 96%

“…In our patients series orchidopexy was performed in 20 cases which had more than 360 (360 - 540) degree and of which 16 were salvaged. Testis in high and transverse position, thickening of epididymis, retractile testis, and some times lack of the cremasteric reflex can cause TT ( 2 , 13 , 18 , 19 ). Boettcher et al ( 20 ) believe that a lack of the cremasteric reflux is another feature highly associated with TT, and was effective as a predictor in half of their patients.…”

Section: Discussionmentioning

confidence: 99%

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Outcomes of Second Look Exploration in Testicular Torsion of Children

2015

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Background:Testicular torsion (TT), or twisting of the testicle resulting in a strangulation of the blood supply, occurs in men whose tissue surrounding the testicle is not well attached to the scrotum. It is important to emphasize that testicular torsion is a medical emergency.Objectives:The aim of this study is to evaluate the second look exploration and outcomes in TT.Patients and Methods:Seventy boys out of 124 patients underwent early exploration and 48 hours later second look exploration due to TT. All patients were checked with preoperative color-doppler ultrasonography (CDU) and intraoperative bleeding test. Data included age at admission, side of pathology, relation of TT with season of year, duration of preoperative history, degree of testicular torsion, CDU findings, and degree of bleeding; results of second look exploration, follow-up, and outcomes were analyzed.Results:Totally 70 patients were included in this study within five years, of which mean age was 28.6 ± 32.9 months (range 1 to 144), 48% of our patients had nausea and vomiting. Preoperative CDU showed absent/weak flow in 50 (71%) cases. Winter showed most frequently (44%) referred cases of testicular torsion. Orchidopexy was performed in 44 (63%) and orchidectomy in 26 (37%) cases after second look exploration. Mean follow-up duration was 3.1 ± 1.4 years. 4 (9%) cases in orchidopexy group developed testicular atrophy during follow-up, all four cases had a history of longer than 12 hours and grade II testicular bleeding test intra-operatively. Other orchidopexy patients salvaged. 26 patients, who were in grade III, underwent orchidectomy in second look exploration.Conclusions:TT requires emergency attention. The ischemia time of the testis is traditionally after 6 hours, and imaging or other diagnostic modality should not be a cause of delay. Early surgical exploration is modality of choice, and second look exploration after 48 hours can be more effective and salvageable in these patients.

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Section: Discussionsupporting

confidence: 41%

Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

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Outcomes of Second Look Exploration in Testicular Torsion of Children

2015

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“…It is an emergent condition that mainly affects the pediatric and young adult male population and requires urgent surgical detorsion, since it may result in loss of the affected testicle if not treated promptly by surgery (1–9). Significant ischemic damage of the testis occurs after 4–8 h of torsion (2,3,6), and the salvage rates reduces as the interval between torsion and detorsion increases (1–9), with rates of 90% after 6 h, 50% after 12 h and 10% after 24 h (1,3,7). Germ cell death is induced by testicular ischemia, and is mainly attributed to the reduction in oxygen supply relative to metabolic demands, accumulation of toxic metabolites and depletion of the stored cellular energy.…”

Section: Introductionmentioning

confidence: 99%

Erythropoietin and sildenafil protect against ischemia/reperfusion injury following testicular torsion in adult rats

Kostakis

Zavras

Damaskos

et al. 2017

Experimental and Therapeutic Medicine

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Testicular torsion/detorsion causes severe tissue damage due to ischemia/reperfusion injury. The present study investigated the protective effect of erythropoietin and sildenafil against ischemia/reperfusion injury following unilateral testicular torsion/detorsion in adult rats. A total of 28 adult male rats were included, and were divided into the following groups: Group A (n=5), sham operated; groups B (n=5), C (n=5), D (n=5) and E (n=8), undergoing right testis torsion and detorsion after 90 min. Group B received no drug treatment. Rats in the groups C and D received low-dose (1,000 IU/kg) or high-dose (3,000 IU/kg) erythropoietin, while those in group E received sildenafil (0.7 mg/kg), through intraperitoneal injection after 60 min of torsion. The right testis was extracted 24 h after detorsion, and the tissue was subjected to histopathological examination and immunohistochemical assessment of cleaved caspase-3 expression. Histological alterations and the quality of spermatogenesis were scored according to the Cosentino and the Johnsen scoring systems, respectively. The results demonstrated normal testicular architecture in group A, while the other groups showed ischemic cellular damages, with the worst scores observed in group B. Groups D and E presented better scores compared with group C. Regarding the quality of spermatogenesis, the best scores were observed in group A, and the worst in group B. Groups C, D and E presented similar results, which were improved in comparison to group B, however, not compared to group A. Furthermore, cleaved caspase-3 levels were lower in groups A, D and E, with equal results observed. Group C had higher levels of cleaved caspase-3 compared with these groups, but lower than group B, which presented the highest cleaved caspase-3 levels. In conclusion, erythropoietin and sildenafil protect testis from ischemia/reperfusion injury by decreasing cellular damage and attenuating apoptosis.

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“…The results suggest that factors that cause treatment delays are critical for patients with torsion. TT is a common source of litigation in urological practice ( 21 , 22 ). The most common reasons for litigation tend to be delayed diagnosis, missed diagnosis, and treatment delays.…”

Section: Discussionmentioning

confidence: 99%

Scrotal Exploration for Testicular Torsion and Testicular Appendage Torsion: Emergency and Reality

Zhang

et al. 2015

Iran J Pediatr

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Background:Scrotal exploration is considered the procedure of choice for acute scrotum.Objectives:We evaluated the importance of early diagnosis and testicular salvage on the therapeutic outcomes of patients with pediatric testicular torsion (TT) and testicular appendage torsion (TAT) in our geographic area. Patients and Methods:We performed a retrospective database analysis of patients who underwent emergency surgery for TT or TAT between January 1996 and June 2009. Patient history, physical examination findings, laboratory test results, color Doppler sonography (CDS) results, and surgical findings were reviewed.Results:A total of 65 cases were included in our analysis. Forty-two cases were followed up for at least 3 months. Testicular tenderness was identified as the major clinical manifestation of TT, while only a few patients with TAT presented with swelling. CDS was an important diagnostic modality. The orchiectomy rate was 71% in the TT group.Conclusions:Cases of acute scrotum require attention in our area. Early diagnosis and scrotal exploration could salvage the testis or preserve normal function without the need for surgery.

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Torsion of the Testicle

Abstract: In this review, long-held myths and misperceptions about the evaluation and management of testicular torsion are discussed, and recommendations for the management of patients who present with acute scrotal pain are presented.

Cited by 64 publications

References 60 publications

Outcomes of Second Look Exploration in Testicular Torsion of Children

Outcomes of Second Look Exploration in Testicular Torsion of Children

Erythropoietin and sildenafil protect against ischemia/reperfusion injury following testicular torsion in adult rats

Scrotal Exploration for Testicular Torsion and Testicular Appendage Torsion: Emergency and Reality

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