Overview
Definition
Twisting of the spermatic cord, resulting in strangulation of the gonadal blood supply and subsequent testicular ischemia/necrosis.
Epidemiology
Bimodal peak: Neonates and Post-pubertal boys (ages 12-18).
Etiology & Risk Factors
- 'Bell-clapper' deformity: Failure of normal posterior anchoring of the gubernaculum, leaving the testis free to swing and twist within the tunica vaginalis.
- Often occurs spontaneously during sleep or after trauma/exercise.
Clinical Symptoms
- Sudden, severe, unilateral scrotal pain
- Nausea and vomiting
- High-riding, horizontally oriented testicle
- ABSENT cremasteric reflex (stroking the inner thigh does not elevate the testicle)
Clinical Approach
Diagnosis
- Clinical diagnosis based on history and exam
- Scrotal Doppler Ultrasound: Shows absent or severely decreased blood flow to the affected testicle
- DO NOT DELAY SURGERY for imaging if clinical suspicion is high (time is testicle)
Management
- EMERGENT Urologic Consult
- Surgical Detorsion and bilateral orchiopexy (fixing both testicles to the scrotal wall to prevent future torsion)
- Viability window: >90% salvage rate if detorsed within 6 hours of pain onset. <10% salvage rate if > 24 hours (requires orchiectomy)
Complications
- Testicular infarction and necrosis
- Infertility