- Twisting of testis and spermatic cord, resulting in acute ischemia and loss of testis if unrecognized:
- Intravaginal torsion: occurs within tunica vaginalis, only involves testis and spermatic cord
- Extravaginal torsion: involves twisting of testis, cord, and processus vaginalis as a unit; typically seen in neonates
- System(s) affected: reproductive
Etiology and Pathophysiology
- Initial incomplete twisting of spermatic cord causes venous obstruction, edema of testis, leading to ischemia.
- Complete twisting of the spermatic cord causes arterial occlusion, in addition to the above, leading to rapid ischemia.
- Congenital bell clapper deformity, which is bilateral in at least 2/5 of cases: A high mesorchium (the posterior lateral attachment of the testis to the tunica vaginalis) allows more room for the testis to twist within the tunica vaginalis and is associated intravaginal testicular torsion (2).
- No clear anatomic defect is associated with extravaginal testicular torsion:
- 20% of patients have a history of trauma.
- 1/3 have had prior episodic testicular pain.
- Contraction of cremaster muscle or dartos may play a role and is stimulated by trauma, exercise, cold, and sexual stimulation.
- Increased incidence may be due to increasing weight and size of testis during pubertal development.
- Torsion may occur in either clockwise or counterclockwise direction.
- Familial testicular torsion, although previously rarely reported, may involve as many as 10% of patients.
- May be more common in colder months
- Previous contralateral testicular torsion
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