Testicular torsion

Testicular torsion is a superacute condition caused by the rotation of the testicle around the pedicle and strangulation of the supply arteries. When the blood vessels in the vas deferens are completely strangled, ischemia occurs and subsequent necrosis with partial infarction. In order for the testicle to be saved, the condition must be resolved within six hours of the onset of the problem. Torsion is caused by a strong contraction of the cremaster muscle.

Predisposes to torsion:

• Longer and looser vascular pedicle,
• cryptorchism,
• wide tunica vaginalis,
• long mesorchium,
• weak suspension apparatus of the testis on the tunica dartos.

According to localization, we distinguish torsion:

Vessels of the testis

• extravaginal (the casings of the testis also rotate around the vas deferens – tunica vaginalis),
• intravaginal (rotated only the testes inside the packages),
• torsion of the mesorchy (strangulation of the hanging mesorchy).

Clinical picture

With testicular tension, there is a sudden, sharp pain in the testicle shooting into the groin, swelling and redness of the scrotum. They are not present (unlike epididymitis or orchitis) general symptoms such as fever, malaise, laboratory-detected increased inflammatory markers.

Diagnosis and differential diagnosis

It is important to differentiate this condition from orchitis (rule out parotitis), epididymitis, orchiepididymitis and testicular tumor. Diagnosis is based on history, physical examination, sonography (with Doppler probe) and diaphanoscopy.

Cremaster reflex – by irritating the inner side of the thigh, we cause the testicle to be pulled on the ipsilateral side, if it is elicitable, torsion can be ruled out, but the reflex may not be elicitable even in healthy individuals.

Musculus cremaster

Links

Related articles

• Acute scrotum
• Testicles
• Orchitis acuta
• Cremaster

Literature used

• DVOŘÁČEK, Jan. Urologie :  obecná a speciální urologie. 2. edition. Praha : Karolinum, 1999. pp. 224-225. ISBN 80-7184-745-3.