INTRODUCTION

Testicular torsion is a true urologic emergency. It occurs when the blood supply to the testis is compromised as the vessels twist along the spermatic cord. Early diagnosis and prompt treatment are critical to prevent prolonged ischemia time which is crucial to its prognosis. This paper aimed to present cases of testicular torsion who underwent testis sparing surgery for torsion.

METHODS

Cases of testicular torsion admitted at the institution from January 2023 to July 2024 were reviewed. Demographic data, scrotal ultrasound findings, intraoperative findings and ischemia time were documented. Patients who underwent tunica albuginea fasciotomy with tunica vaginalis flap were monitored post-surgery via scrotal ultrasound, documenting testicular size.

RESULTS

Twenty seven (27) cases of testicular torsion were reviewed. Of these cases, 4 improved after detorsion and orchidopexy, 12 cases with > 72 hours ischemia time and failed detorsion underwent orchiectomy, 11 cases with < 72 hours of ischemia time, tunica albuginea fasciotomy were performed. Five (5) of these 11 cases showed no improvement in appearance and no bleeding was observed and subsequent orchiectomy was performed. Six cases demonstrated improvement in appearance and bleeding after tunica albuginea fasciotomy, tunica vaginalis flap used to cover the resulting defect. Of these 6 cases, 2 cases showed intact testicular size, 1 case had testicular atrophy on monitoring and 3 cases were lost to follow-up.

CONCLUSION

Testicular torsion remains to be a critical urologic emergency. Prompt diagnosis and immediate surgery required to improve salvage rates. Tunica albuginea incision, with subsequent tunica vaginalis flap may be an option for the urologist to improve salvage, although not consistently prevent testicular atrophy.

Human ; Male ; Testicular Torsion ; Spermatic Cord Torsion

Cryptorchidism or an undescended testis is one of the most common congenital anomalies found at birth and affects about 3% of full-term male newborns. A cryptorchid testis can be located anywhere between the abdominal cavity and just outside the scrotum, and 80% of undescended testes are palpable. Approximately three-fourths of cryptorchid testes will spontaneously descend, usually by 3 months of age. Children with retractile testes require annual follow-up until puberty or the testis is no longer retractile. Determination of whether the testis is present on physical examination is critically important because it guides further workup and treatment. Although radiological evaluation does not have a relevant role in the assessment of undescended testes and would not influence surgical management, many physicians have been performed it to verify the location and condition of cryptorchid testis. The efficacy of hormonal treatment is less than 20% and is significantly dependent on pretreatment testicular location. Therefore, surgical repositioning of the testis within the scrotal sac, i.e., orchiopexy, remains the gold standard for the management of undescended testes and it should be performed between 6 and 12 months of age because spontaneous descent occurs uncommonly thereafter, and in order to prevent the complications and long-term sequelae of cryptorchidism, such as testicular torsion, trauma, infertility, and testicular cancer. Recently, laparoscopy has attained its greatest degree of general acceptance, both diagnostically and therapeutically, in the realm of pediatric urology for the management of a nonpalpable testis.
Abdominal Cavity ; Child ; Cryptorchidism ; Follow-Up Studies ; Humans ; Infant, Newborn ; Infertility ; Laparoscopy ; Male ; Orchiopexy ; Parturition ; Physical Examination ; Puberty ; Scrotum ; Spermatic Cord Torsion ; Testicular Neoplasms ; Testis ; Urology

Acute scrotum in newborn infants is unusual and it is even more unusual with infectious origin. The causes of acute scrotum in newborn infants include hydrocele, testicular torsion, torsion of an appendix testis, epididymo-orchitis, meconium peritonitis, testicular tumor, scrotal hematoma and reducible or incarcerated inguinal hernia. Because of lack of typical symptoms and signs, the correct diagnosis of surgical emergencies such as testicular torsion and incarcerated inguinal hernia are often delayed. Recently, color Doppler ultrasonography and testicular scans are being used for differential diagnosis of acute scrotum, although the latter is often technically unsatisfactory due to small size of the testicles in newborn infants. We report a seven day-old male infant with acute scrotum who was diagnosed as acute epididymo-orchitis by color Doppler ultrasonography, and saved from unnecessary surgical interventions. Although color Doppler ultrasonography can not give diagnostic clue for acute scrotum, it can reduce the need for explorative surgery.
Appendix ; Diagnosis ; Diagnosis, Differential ; Emergencies ; Hematoma ; Hernia, Inguinal ; Humans ; Infant ; Infant, Newborn* ; Male ; Meconium ; Peritonitis ; Scrotum ; Spermatic Cord Torsion ; Testicular Hydrocele ; Testis ; Ultrasonography, Doppler, Color

The testicular prosthesis can be an afterthought for providers when performing an orchiectomy for testicular cancer, torsion, atrophic testis, or trauma. However, data suggest that patients find the offer of a testicular prosthesis and counseling regarding placement to be extremely important from both a pragmatic and a psychosocial perspective. Only two-thirds of men undergoing orchiectomy are offered an implant at the time of orchiectomy and of those offered about one-third move forward with prosthesis placement. The relatively low acceptance rate is in stark contrast with high patient satisfaction and low complication rates for those who undergo the procedure. The most common postoperative patient concerns are minor and involve implant positioning, size, and weight. Herein, we provide an up-to-date review of modern preoperative evaluation, patient selection, expectation management, surgical technique, and expected outcomes for testicular prostheses.
Counseling ; Gonadal Dysgenesis, 46,XY/surgery* ; Humans ; Male ; Orchiectomy ; Patient Satisfaction ; Patient Selection ; Postoperative Complications/epidemiology* ; Prosthesis Implantation/methods* ; Spermatic Cord Torsion/surgery* ; Testicular Diseases/surgery* ; Testicular Neoplasms/surgery* ; Testis/surgery* ; Urologic Surgical Procedures, Male/methods*

OBJECTIVETo study the causes of orchiectomy in different age groups.

METHODSWe retrospectively reviewed the clinical data about 291 cases of orchiectomy performed between March 1993 and October 2014 and analyzed the causes of surgery and their distribution in different age groups.

RESULTSThe main causes of orchiectomy were testicular torsion (45.8%), cryptorchidism (32.5%) and testicular tumor (16.9%) in the patients aged 0-25 years, testicular tumor (42.4%), cryptorchidism (25.9%) and tuberculosis (10.6%) in those aged 26-50 years. Prostate cancer was the leading cause in those aged 51-75 years (77.6%) or older (84.0%)), and testicular tumor was another cause in the 51-75 years old men (10.2%). Prostate cancer, testicular tumor, cryptorchidism, and testicular torsion were the first four causes of orchiectomy between 1993 and 2009. From 2010 to 2014, however, testicular tumor rose to the top while prostate cancer dropped to the fourth place.

CONCLUSIONThe causes of orchiectomy vary in different age groups. The proportion of castration for prostate cancer patients significantly reduced in the past five years, which might be attributed to the improvement of comprehensive health care service.

Adolescent ; Adult ; Age Factors ; Aged ; Causality ; Child ; Child, Preschool ; Cryptorchidism ; surgery ; Humans ; Infant ; Infant, Newborn ; Male ; Middle Aged ; Orchiectomy ; statistics & numerical data ; Prostatic Neoplasms ; surgery ; Retrospective Studies ; Spermatic Cord Torsion ; surgery ; Testicular Neoplasms ; surgery ; Tuberculosis, Male Genital ; surgery ; Young Adult

We report 2 cases of intrauterine unilateral testicular torsion This experience reemphasizes the necessity of a careful and complete examination of the newborn immediate after delivery. The presence of a scrotal mass in a newborn that does not transilluminate represent trosion of the spermatic cord until proved otherwise, and demands immediate surgical intervention through an inguinal approach for accurate diagnosis and appropriate therapy.
Diagnosis ; Humans ; Infant, Newborn ; Spermatic Cord ; Spermatic Cord Torsion*

We recently encountered a very rare case of torsion of an intrascrotal testicular tumor in a 26-year-old male. Unlike the intra-abdominal undescended testis, intrascrotal spermatic cord torsion associated with a testicular tumor has rarely been reported. We write to report a case of intrascrotal spermatic cord torsion accompanied by a testicular tumor that had been overlooked preoperatively.
Adult ; Cryptorchidism ; Humans ; Male ; Seminoma ; Spermatic Cord ; Spermatic Cord Torsion

Hospital from recent 6 years. The age range extended from 1 month to 34 years with 11 cases arising between the age of 10 and 19. The duration of torsion was less than 6 hours in 2 cases, 6-24 hours in 9 cases and 24 hours or longer in 10 cases. The testicular salvage rate was 100% (11/ II) for the patients operated within less than 24 hours after torsion. and 44% (4/9) for the patients over .24 hours. The degree of torsion was less than 180 degrees in 12 cases, whose testicular salvage rate was 100%. Among the 8 cases who had more than 360 degrees of torsion, orchiectomy was performed in 5 cases. But the duration of torsion of all these cases was more than 24 hours. Thus the testicular salvage in patients with testicular torsion was closely related to the duration of torsion and early scrotal exploration should be done in patients with suspicious testicular torsion.
Humans ; Orchiectomy ; Spermatic Cord Torsion ; Testis*

Because of its motility and position, the scrotum is infrequently injured after blunt trauma. We have recently experienced traumatic testicular torsion, testicular rupture, and epididymal rupture with abscess formation after blunt scrotal trauma. We have explored early and treated properly.
Abscess ; Rupture ; Scrotum ; Spermatic Cord Torsion

Unilateral torsion of the testis was experimentally induced in Sprague-Dowley rats by an incision in the scrotum and manual rotation of the testis. The testes remained torted for 3 or 24 hours and then were released by detorsion or orchiectomy. Histologic changes were evaluated 2 weeks and 4 weeks post torsion episode in order to answer the following questions:(1) Does the duration of testicular torsion affect the degree of histologic change in the contralateral testis? (2) Does the treatment of the torted testis influence the contralateral testis histologically? (3) Are there any histologic differences according to the duration of the follow-up in each group? The results indicate that when a torted testis was kept in place for at least 24 hrs, then was a marked decrease in spermatogenesis, but even this histologic change disappeared 4 weeks later. In conclusion a torted testis may present a liability to the patient's contralateral testis, but this phenomena is temporal.
Animal ; Male ; Rats ; Rats, Inbred Strains ; Spermatic Cord Torsion/complications ; Spermatic Cord Torsion/pathology*