Acute Scrotum, Acute Swelling or Pain of the Scrotum and/or Testis Torsion of the Testis | |
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Incidence | |
The torsion of the testis may occur at any age in childhood. It is relatively frequent perinatally and during puberty. | |
Clinical significance | |
1. A delayed diagnosis and treatment can lead to an irreversible damage to the testis and to a later loss of fertility. | |
Etiology | |
In 85 percent there is an intravaginal torsion, in which twisting is promoted by high investment of the cord by the tunica vaginalis. This variation is bilateral. | |
Pathology, anatomical types | Illustrations |
In contrast to the intravaginal torsion of the testicle where the torsion occurs within the tunica vaginalis, in the extravaginal torsion the entire spermatic cord is twisting above the upper end of the tunica vaginalis. The latter is observed mainly perinatally. | show details |
Pathophysiology | Illustrations |
The degree and sequels of ischemia depend on the duration of torsion and the degree of torsion in the clockwise or counterclockwise direction. In addition some pre-existing histological changes may be observed similar to those in cryptorchidism. | show details |
Clinical Presentation (history, findings, clinical skills) | Illustrations |
History: Spontaneously or following sport sudden onset or less frequently gradual increase of severe pain in the scrotum and in the groin and the lower abdomen occurs associated with nausea and vomiting. | show details |
Natural history | |
Without treatment loss of the testicle of the involved side, and total loss of fertility because torsion may occur sooner or later on the other side, too. On the other hand slight types of torsion with spontaneous reduction may occur. They can lead to recurrent pains in the scrotum and the groin and to false-negative ultrasound findings. | |
Differential diagnosis | Illustration Figure |
The differential diagnosis includes lesions leading to an acute scrotum, an abdominal emergency, or recurrent pains in the scrotum or in the groin. | show details |
Work-up examinations | Illustrations |
In case of a reliable clinical diagnosis or an urgent suspicion of testicular torsion additional examinations are not necessary. | show details |
Therapy | Illustrations |
Immediate revision, untwisting of the torsion, and fixation of the testicle to avoid further torsion, the latter is performed also on the opposite side. | show details |
Prognosis | |
Following a torsion of more than 24 hours and of 360 degree and more, total loss of the testicle in more than 50 percent.
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