eMedicine Specialties > Urology > Common Problems of the Testicle

Testicular Torsion: Follow-up

Author: Eugene Minevich, MD, Assistant Professor, Department of Surgery, Division of Pediatric Urology, University of Cincinnati
Coauthor(s): Leslie Tackett, MD, Fellow, Departments of Surgery and Pediatrics, Division of Pediatric Urology, Children's Hospital Medical Center at Cincinnati
Contributor Information and Disclosures

Updated: Feb 9, 2007

Outcome and Prognosis

Success in the management of spermatic cord torsion is measured by immediate testicular salvage and incidence of late testicular atrophy, which are, in turn, directly related to the duration and degree of testicular torsion. Delaying surgical intervention worsens the intraoperative testicular salvage and incidence rate and the extent of subsequent testicular atrophy. The delay between the onset of symptoms and the time of surgical or manual detorsion is obviously of utmost importance in achieving a viable testis.

Future and Controversies

Recent studies show that exocrine and endocrine function is substandard in men with a history of unilateral torsion. The following 3 theories explain the contralateral disease noted in torsion:

  • Unrecognized or unreported repeated injury to both testes
  • Preexisting pathologic condition predisposing to both abnormal spermatogenesis and torsion of the spermatic cord
  • Induction of pathologic changes in the contralateral testis by retention of the injured testis

To explain the decreased fertility observed in unilateral torsion of the spermatic cord, several specialists suggest an autoimmune mechanism. This hypothesis is based upon the following:

  • Knowledge of the blood-testis barrier, which isolates the luminal compartment of the seminiferous tubule
  • Inducing experimental allergic orchitis
  • Likening contralateral testicular disease to sympathetic ophthalmia, a cell-mediated immune response
 


More on Testicular Torsion

Overview: Testicular Torsion
Workup: Testicular Torsion
Treatment: Testicular Torsion
Follow-up: Testicular Torsion
Multimedia: Testicular Torsion
References
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References

  1. Barada JH, Weingarten JL, Cromie WJ. Testicular salvage and age-related delay in the presentation of testicular torsion. J Urol. Sep 1989;142(3):746-8. [Medline].

  2. Brandt MT, Sheldon CA, Wacksman J, Matthews P. Prenatal testicular torsion: principles of management. J Urol. Mar 1992;147(3):670-2. [Medline].

  3. Johnston BI, Wiener JS. Intermittent testicular torsion. BJU Int. May 2005;95(7):933-4. [Medline].

  4. Lewis AG, Bukowski TP, Jarvis PD, et al. Evaluation of acute scrotum in the emergency department. J Pediatr Surg. Feb 1995;30(2):277-81; discussion 281-2. [Medline].

  5. Mor Y, Pinthus JH, Nadu A, et al. Testicular fixation following torsion of the spermatic cord--does it guarantee prevention of recurrent torsion events?. J Urol. Jan 2006;175(1):171-3; discussion 173-4.

  6. Rabinowitz R, Hulbert WC Jr. Acute scrotal swelling. Urol Clin North Am. Feb 1995;22(1):101-5. [Medline].

  7. Smith-Harrison LI, Koontz WW. Torsion of the Testis: Changing Concepts. AUA Updates. 1990;32.

  8. Sun J, Liu GH, Zhao HT, Shi CR. Long-term influence of prepubertal testicular torsion on spermatogenesis. Urol Int. 2006;77(3):275-8.

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Further Reading

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Keywords

testicular torsion, intravaginal testicular torsion, extravaginal testicular torsion, torsion of the spermatic cord, torsion of the testis, epididymitis, orchitis, epididymo-orchitis, pyuria, bacteriuria, leucocytosis, contralateral orchidopexy, orchiectomy, testicular necrosis, testicular atrophy, scrotal swelling, intermittent testicular torsion, acute scrotum, bell-clapper deformity

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Contributor Information and Disclosures

Author

Eugene Minevich, MD, Assistant Professor, Department of Surgery, Division of Pediatric Urology, University of Cincinnati
Eugene Minevich, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Surgeons, and American Urological Association
Disclosure: Nothing to disclose.

Coauthor(s)

Leslie Tackett, MD, Fellow, Departments of Surgery and Pediatrics, Division of Pediatric Urology, Children's Hospital Medical Center at Cincinnati
Leslie Tackett, MD is a member of the following medical societies: American Urological Association
Disclosure: Nothing to disclose.

Medical Editor

Raymond Rackley, MD, Professor of Surgery, Cleveland Clinic Lerner College of Medicine at CWRU; Co-Section Head, Section of Voiding Dysfunction and Female Urology, Glickman Urological Institute, Cleveland Clinic Foundation
Raymond Rackley, MD is a member of the following medical societies: American Urological Association
Disclosure: Pfizer, Novartis, Proctor & Gamble, Allergan Honoraria None; Pfizer, Novartis, Proctor & Gamble, Allergan Consulting fee Other

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Shlomo Raz, MD, Professor, Department of Surgery, Division of Urology, University of California at Los Angeles School of Medicine
Shlomo Raz, MD is a member of the following medical societies: American College of Surgeons, American Medical Association, American Urological Association, and California Medical Association
Disclosure: Nothing to disclose.

CME Editor

J Stuart Wolf, Jr, MD, FACS, David A Bloom Professor of Urology, Director, Division of Minimally Invasive Urology, Department of Urology, University of Michigan Medical Center
J Stuart Wolf, Jr, MD, FACS is a member of the following medical societies: American College of Surgeons, American Medical Association, American Urological Association, Catholic Medical Association, Endourological Society, Society for Urology and Engineering, Society of Laparoendoscopic Surgeons, and Society of University Urologists
Disclosure: Terumo Corporation Consulting fee Consulting; Omeros Corporation Consulting fee Consulting

Chief Editor

William J Cromie, MD, MBA, President and Chief Executive Officer, Health Care, Capital District Physicians' Health Plan
William J Cromie, MD, MBA is a member of the following medical societies: American Academy of Pediatrics, American College of Surgeons, American Medical Association, American Urological Association, Medical Society of the State of New York, Société Internationale d'Urologie (International Society of Urology), Society for Pediatric Urology, Society of University Urologists, and Society of Uroradiology
Disclosure: Nothing to disclose.

 
 
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