Epidemiology

Peak incidence: neonatal period (first 30 days of life) and during puberty (10–14 years)

Etiology

• Idiopathic
• Iatrogenic
  • Following a testicular procedure with incorrect positioning of testis

Pathophysiology

• Testicular torsion is a sudden twisting of the spermatic cord (and vascular pedicle) associated with a poorly secured testis.
  • Because of a congenital abnormality in which the tunica vaginalis attaches to the superior pole of the testis (bell-clapper deformity) → increased mobility of testis within tunica vaginalis, with possible abnormal transverse lie of testis → torsion of the testis (along the spermatic cord)
• Torsion results in venous engorgement with consequent arterial compromise, tissue ischemia, and possible infarction.
• Irreversible damage occurs after 6–12 hours of torsion.

Clinical features

• Abrupt onset of severe testicular pain and/or pain in the lower abdomen
• swollen and tender testis
• Nausea and vomiting
• Abnormal position of the testis
  • Scrotal elevation (high-riding testis)
• Absent cremasteric reflex
  • Impairment of nerves within the cord
• Negative Prehn sign
  • A physical examination finding in which elevation of the scrotum relieves testicular pain. A positive Prehn sign is associated with epididymitis; a negative Prehn sign is associated with testicular torsion.
  • Elevation of the scrotum can improve venous drainage and relieve edema in epididymitis; but cannot relieve ischemia in testicular torsion.

Diagnostics

Treatment