Pediatric Testicular Torsion Clinical Presentation

1. Bowlin PR, Gatti JM, Murphy JP. Pediatric Testicular Torsion. Surg Clin North Am. 2017 Feb. 97 (1):161-172. [QxMD MEDLINE Link].

2. Ringdahl E, Teague L. Testicular torsion. Am Fam Physician. 2006 Nov 15. 74(10):1739-43. [QxMD MEDLINE Link].

3. Chapman RH, Walton AJ. Torsion of the testis and its appendages. Br Med J. 1972 Jan 15. 1(5793):164-6. [QxMD MEDLINE Link]. [Full Text].

4. Gilchrist BF, Lobe TE. The acute groin in pediatrics. Clin Pediatr (Phila). 1992 Aug. 31(8):488-96. [QxMD MEDLINE Link].

5. Hutson JM. Undescended testis, torsion, and varicocele. Coran AG, Adzick NS, Caldamone AA, Krummel TM, Laberge J-M, Shamberger RC, eds. Pediatric Surgery. 7th ed. Philadelphia: Elsevier Saunders; 2012. Vol 2: 1003-20.

6. Gatti JM, Patrick Murphy J. Current management of the acute scrotum. Semin Pediatr Surg. 2007 Feb. 16(1):58-63. [QxMD MEDLINE Link].

7. Cattolica EV. Preoperative manual detorsion of the torsed spermatic cord. J Urol. 1985 May. 133(5):803-5. [QxMD MEDLINE Link].

8. Sessions AE, Rabinowitz R, Hulbert WC, Goldstein MM, Mevorach RA. Testicular torsion: direction, degree, duration and disinformation. J Urol. 2003 Feb. 169(2):663-5. [QxMD MEDLINE Link].

9. Mansbach JM, Forbes P, Peters C. Testicular torsion and risk factors for orchiectomy. Arch Pediatr Adolesc Med. 2005 Dec. 159(12):1167-71. [QxMD MEDLINE Link].

10. Capra AP, Ferro E, La Rosa MA, Briuglia S, Russo T, Arena S, et al. Genetic analysis of the human insulin-like 3 gene in pediatric patients with testicular torsion. Pediatr Surg Int. 2018 Jul. 34 (7):807-812. [QxMD MEDLINE Link].

11. Caesar RE, Kaplan GW. Incidence of the bell-clapper deformity in an autopsy series. Urology. 1994 Jul. 44(1):114-6. [QxMD MEDLINE Link].

12. Cilento BG, Najjar SS, Atala A. Cryptorchidism and testicular torsion. Pediatr Clin North Am. 1993 Dec. 40(6):1133-49. [QxMD MEDLINE Link].

13. Ferro F, Iacobelli B. Polyorchidism and torsion. A lesson from 2 cases. J Pediatr Surg. 2005 Oct. 40(10):1662-4. [QxMD MEDLINE Link].

14. Favorito LA, Cavalcante AG, Costa WS. Anatomic aspects of epididymis and tunica vaginalis in patients with testicular torsion. Int Braz J Urol. 2004 Sep-Oct. 30(5):420-4. [QxMD MEDLINE Link].

15. Anderson JB, Williamson RC. Testicular torsion in Bristol: a 25-year review. Br J Surg. 1988 Oct. 75(10):988-92. [QxMD MEDLINE Link].

16. Gatti JM, Pettiford J. The acute scrotum. Holcomb GW III, Murphy PJ, Ostlie DJ, eds. Ashcraft's Pediatric Surgery. 6th ed. Philadelphia: Elsevier Saunders; 2014. 702-6.

17. Williamson RC. Torsion of the testis and allied conditions. Br J Surg. 1976 Jun. 63(6):465-76. [QxMD MEDLINE Link].

18. Zhao LC, Lautz TB, Meeks JJ, Maizels M. Pediatric testicular torsion epidemiology using a national database: incidence, risk of orchiectomy and possible measures toward improving the quality of care. J Urol. 2011 Nov. 186 (5):2009-13. [QxMD MEDLINE Link].

19. Kylat RI. Perinatal testicular torsion. Arch Pediatr. 2021 Jan. 28 (1):75-79. [QxMD MEDLINE Link].

20. Ramachandra P, Palazzi KL, Holmes NM, Marietti S. Factors influencing rate of testicular salvage in acute testicular torsion at a tertiary pediatric center. West J Emerg Med. 2015 Jan. 16(1):190-4. [QxMD MEDLINE Link]. [Full Text].

21. Castañeda-Sánchez I, Tully B, Shipman M, Hoeft A, Hamby T, Palmer BW. Testicular torsion: A retrospective investigation of predictors of surgical outcomes and of remaining controversies. J Pediatr Urol. 2017 Oct. 13 (5):516.e1-516.e4. [QxMD MEDLINE Link].

22. Davenport M. ABC of general surgery in children. Acute problems of the scrotum. BMJ. 1996 Feb 17. 312(7028):435-7. [QxMD MEDLINE Link]. [Full Text].

23. Bennett S, Nicholson MS, Little TM. Torsion of the testis: why is the prognosis so poor?. Br Med J (Clin Res Ed). 1987 Mar 28. 294(6575):824. [QxMD MEDLINE Link]. [Full Text].

24. Nasrallah P, Nair G, Congeni J, Bennett CL, McMahon D. Testicular health awareness in pubertal males. J Urol. 2000 Sep. 164(3 Pt 2):1115-7. [QxMD MEDLINE Link].

25. Tryfonas G, Violaki A, Tsikopoulos G, Avtzoglou P, Zioutis J, Limas C, et al. Late postoperative results in males treated for testicular torsion during childhood. J Pediatr Surg. 1994 Apr. 29(4):553-6. [QxMD MEDLINE Link].

26. Scheiber K, Marberger H, Bartsch G. Exocrine and endocrine testicular function in patients with unilateral testicular disease. J R Soc Med. 1983 Aug. 76(8):649-51. [QxMD MEDLINE Link]. [Full Text].

27. Ozkan KU, Küçükaydin M, Muhtaroglu S, Kontas O. Evaluation of contralateral testicular damage after unilateral testicular torsion by serum inhibin B levels. J Pediatr Surg. 2001 Jul. 36(7):1050-3. [QxMD MEDLINE Link].

28. Puri P, Barton D, O'Donnell B. Prepubertal testicular torsion: subsequent fertility. J Pediatr Surg. 1985 Dec. 20(6):598-601. [QxMD MEDLINE Link].

29. Goetz J, Roewe R, Doolittle J, Roth E, Groth T, Mesrobian HG, et al. A comparison of clinical outcomes of acute testicular torsion between prepubertal and postpubertal males. J Pediatr Urol. 2019 Dec. 15 (6):610-616. [QxMD MEDLINE Link].

30. Rabinowitz R. The importance of the cremasteric reflex in acute scrotal swelling in children. J Urol. 1984 Jul. 132(1):89-90. [QxMD MEDLINE Link].

31. Nelson CP, Williams JF, Bloom DA. The cremasteric reflex: a useful but imperfect sign in testicular torsion. J Pediatr Surg. 2003 Aug. 38(8):1248-9. [QxMD MEDLINE Link].

32. Kalfa N, Veyrac C, Lopez M, Lopez C, Maurel A, Kaselas C, et al. Multicenter assessment of ultrasound of the spermatic cord in children with acute scrotum. J Urol. 2007 Jan. 177(1):297-301; discussion 301. [QxMD MEDLINE Link].

33. Karmazyn B, Steinberg R, Livne P, Kornreich L, Grozovski S, Schwarz M, et al. Duplex sonographic findings in children with torsion of the testicular appendages: overlap with epididymitis and epididymoorchitis. J Pediatr Surg. 2006 Mar. 41(3):500-4. [QxMD MEDLINE Link].

34. Mor Y, Pinthus JH, Nadu A, Raviv G, Golomb J, Winkler H, et al. Testicular fixation following torsion of the spermatic cord--does it guarantee prevention of recurrent torsion events?. J Urol. 2006 Jan. 175(1):171-3; discussion 173-4. [QxMD MEDLINE Link].

35. Steinhardt GF, Boyarsky S, Mackey R. Testicular torsion: pitfalls of color Doppler sonography. J Urol. 1993 Aug. 150(2 Pt 1):461-2. [QxMD MEDLINE Link].

36. Ingram S, Hollman AS, Azmy A. Testicular torsion: missed diagnosis on colour Doppler sonography. Pediatr Radiol. 1993. 23(6):483-4. [QxMD MEDLINE Link].

37. Riccabona M, Darge K, Lobo ML, Ording-Muller LS, Augdal TA, Avni FE, et al. ESPR Uroradiology Taskforce--imaging recommendations in paediatric uroradiology, part VIII: retrograde urethrography, imaging disorder of sexual development and imaging childhood testicular torsion. Pediatr Radiol. 2015 Dec. 45 (13):2023-8. [QxMD MEDLINE Link]. [Full Text].

38. Gaither TW, Copp HL. State appellant cases for testicular torsion: Case review from 1985 to 2015. J Pediatr Urol. 2016 Oct. 12 (5):291.e1-291.e5. [QxMD MEDLINE Link]. [Full Text].

39. Nussbaum Blask AR, Rushton HG. Sonographic appearance of the epididymis in pediatric testicular torsion. AJR Am J Roentgenol. 2006 Dec. 187(6):1627-35. [QxMD MEDLINE Link].

40. Schalamon J, Ainoedhofer H, Schleef J, Singer G, Haxhija EQ, Höllwarth ME. Management of acute scrotum in children--the impact of Doppler ultrasound. J Pediatr Surg. 2006 Aug. 41(8):1377-80. [QxMD MEDLINE Link].

41. Kravchick S, Cytron S, Leibovici O, Linov L, London D, Altshuler A, et al. Color Doppler sonography: its real role in the evaluation of children with highly suspected testicular torsion. Eur Radiol. 2001. 11(6):1000-5. [QxMD MEDLINE Link].

42. McDowall J, Adam A, Gerber L, Enyuma COA, Aigbodion SJ, Buchanan S, et al. The ultrasonographic "whirlpool sign" in testicular torsion: valuable tool or waste of valuable time? A systematic review and meta-analysis. Emerg Radiol. 2018 Jun. 25 (3):281-292. [QxMD MEDLINE Link].

43. Sidhu PS. Clinical and imaging features of testicular torsion: role of ultrasound. Clin Radiol. 1999 Jun. 54(6):343-52. [QxMD MEDLINE Link].

44. Luscombe CJ, Mountford PJ, Coppinger SM, Gadd R. Diagnosing testicular torsion. Isotope scanning is useful. BMJ. 1996 May 25. 312(7042):1358-9. [QxMD MEDLINE Link]. [Full Text].

45. Shadgan B, Fareghi M, Stothers L, Macnab A, Kajbafzadeh AM. Diagnosis of testicular torsion using near infrared spectroscopy: A novel diagnostic approach. Can Urol Assoc J. 2014 Mar. 8(3-4):E249-52. [QxMD MEDLINE Link]. [Full Text].

46. Schoenfeld EM, Capraro GA, Blank FS, Coute RA, Visintainer PF. Near-infrared spectroscopy assessment of tissue saturation of oxygen in torsed and healthy testes. Acad Emerg Med. 2013 Oct. 20(10):1080-3. [QxMD MEDLINE Link].

47. Schlomer BJ, Keays MA, Grimsby GM, Granberg CF, DaJusta DG, Menon VS, et al. Trans-scrotal Near Infrared Spectroscopy as a Diagnostic Test for Testis Torsion in Pediatric Acute Scrotum: A Prospective Comparison to Gold Standard Diagnostic Test Study. J Urol. 2017 Apr 6. [QxMD MEDLINE Link].

48. Ye H, Liu Z, Wang H, Chang Y, Gao X, Xu C, et al. A Minimally Invasive Method in Diagnosing Testicular Torsion: The Initial Experience of Scrotoscope. J Endourol. 2016 Jun. 30 (6):704-8. [QxMD MEDLINE Link].

49. Hong H, Cai W, Wu J, Wu X, Lin L, Li T, et al. Scrotoscopy and traditional open surgery shows a high degree of consistency in the diagnosis of testicular torsion: An initial report. Medicine (Baltimore). 2020 Jul 31. 99 (31):e21545. [QxMD MEDLINE Link]. [Full Text].

50. Xu L, Li CQ, Qiu MJ, Yang Y. [Scrotoscopy in the diagnosis and treatment of testicular and epididymal diseases: Analysis of 39 cases]. Zhonghua Nan Ke Xue. 2020 Feb. 26 (2):134-138. [QxMD MEDLINE Link].

51. Cuervo JL, Grillo A, Vecchiarelli C, Osio C, Prudent L. Perinatal testicular torsion: a unique strategy. J Pediatr Surg. 2007 Apr. 42(4):699-703. [QxMD MEDLINE Link].

52. Lee SD, Cha CS. Asynchronous bilateral torsion of the spermatic cord in the newborn: a case report. J Korean Med Sci. 2002 Oct. 17(5):712-4. [QxMD MEDLINE Link]. [Full Text].

53. Abasiyanik A, Dagdönderen L. Beneficial effects of melatonin compared with allopurinol in experimental testicular torsion. J Pediatr Surg. 2004 Aug. 39(8):1238-41. [QxMD MEDLINE Link].

54. Ozkan KU, Boran C, Kilinç M, Garipardiç M, Kurutas EB. The effect of zinc aspartate pretreatment on ischemia-reperfusion injury and early changes of blood and tissue antioxidant enzyme activities after unilateral testicular torsion-detorsion. J Pediatr Surg. 2004 Jan. 39(1):91-5. [QxMD MEDLINE Link].

55. Aksoy H, Yapanoglu T, Aksoy Y, Ozbey I, Turhan H, Gursan N. Dehydroepiandrosterone treatment attenuates reperfusion injury after testicular torsion and detorsion in rats. J Pediatr Surg. 2007 Oct. 42(10):1740-4. [QxMD MEDLINE Link].

56. Garel L, Dubois J, Azzie G, Filiatrault D, Grignon A, Yazbeck S. Preoperative manual detorsion of the spermatic cord with Doppler ultrasound monitoring in patients with intravaginal acute testicular torsion. Pediatr Radiol. 2000 Jan. 30(1):41-4. [QxMD MEDLINE Link].

57. Cornel EB, Karthaus HF. Manual derotation of the twisted spermatic cord. BJU Int. 1999 Apr. 83(6):672-4. [QxMD MEDLINE Link].

58. Siu Uribe A, Garrido Pérez JI, Vázquez Rueda F, Ibarra Rodrígue MR, Murcia Pascual FJ, Ramnarine Sánchez SD, et al. [Manual detorsion and elective orchiopexy as an alternative treatment for acute testicular torsion in children]. Cir Pediatr. 2019 Jan 21. 32 (1):17-21. [QxMD MEDLINE Link].

59. Frank JD, O'Brien M. Fixation of the testis. BJU Int. 2002 Mar. 89(4):331-3. [QxMD MEDLINE Link].

60. Olguner M, Akgür FM, Aktug T, Derebek E. Bilateral asynchronous perinatal testicular torsion: a case report. J Pediatr Surg. 2000 Sep. 35(9):1348-9. [QxMD MEDLINE Link].

61. Abdelhalim A, Chamberlin JD, McAleer IM. A Survey of the Current Practice Patterns of Contralateral Testis Fixation in Unilateral Testicular Conditions. Urology. 2018 Jun. 116:156-160. [QxMD MEDLINE Link].

62. Kass EJ, Stone KT, Cacciarelli AA, Mitchell B. Do all children with an acute scrotum require exploration?. J Urol. 1993 Aug. 150(2 Pt 2):667-9. [QxMD MEDLINE Link].

63. Arda IS, Ozyaylali I. Testicular tissue bleeding as an indicator of gonadal salvageability in testicular torsion surgery. BJU Int. 2001 Jan. 87(1):89-92. [QxMD MEDLINE Link].

64. Steinbecker KM, Teague JL, Wiltfong DB, Wakefield MR. Testicular histology after transparenchymal fixation using polytetrefluoroethylene suture: an animal model. J Pediatr Surg. 1999 Dec. 34(12):1822-5. [QxMD MEDLINE Link].

65. Kuntze JR, Lowe P, Ahlering TE. Testicular torsion after orchiopexy. J Urol. 1985 Dec. 134(6):1209-10. [QxMD MEDLINE Link].

66. Morse TS, Hollabaugh RS. The "window" orchidopexy for prevention of testicular torsion. J Pediatr Surg. 1977 Apr. 12(2):237-40. [QxMD MEDLINE Link].

67. Hoseinpour M, Memarzadeh M, Sadeqi A. Comparative investigation of two surgical techniques of orchiopexy in the post-operative recurrence rate and testicular size in children in clinical trial study. Adv Biomed Res. 2015. 4:171. [QxMD MEDLINE Link]. [Full Text].

68. Lian BS, Ong CC, Chiang LW, Rai R, Nah SA. Factors Predicting Testicular Atrophy after Testicular Salvage following Torsion. Eur J Pediatr Surg. 2016 Feb. 26 (1):17-21. [QxMD MEDLINE Link].

69. Grimsby GM, Schlomer BJ, Menon VS, Ostrov L, Keays M, Sheth KR, et al. Prospective Evaluation of Predictors of Testis Atrophy After Surgery for Testis Torsion in Children. Urology. 2018 Jun. 116:150-155. [QxMD MEDLINE Link]. [Full Text].

70. Lewis RL, Roller MD, Parra BL, Cotlar AM. Torsion of an intra-abdominal testis. Curr Surg. 2000 Sep 1. 57(5):497-499. [QxMD MEDLINE Link].

Krishna Kumar Govindarajan, MBBS, MCh, MS, MRCS, DNB Professor of Pediatric Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, India

Krishna Kumar Govindarajan, MBBS, MCh, MS, MRCS, DNB is a member of the following medical societies: American College of Surgeons, Association of Colon and Rectal Surgeons of India, Association of Minimal Access Surgeons of India, Association of Surgeons of India, British Association of Paediatric Surgeons, Indian Association of Pediatric Surgeons, International College of Surgeons, National Academy of Medical Sciences (India)

Disclosure: Nothing to disclose.

Caleb P Nelson, MD, MPH Assistant Professor of Surgery (Urology), Department of Urology, Harvard Medical School; Consulting Staff, Department of Urology, Children's Hospital Boston

Caleb P Nelson, MD, MPH is a member of the following medical societies: American Urological Association, Endourological Society, Phi Beta Kappa, Societies for Pediatric Urology, Society for Fetal Urology

Disclosure: Nothing to disclose.

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Marc Cendron, MD Associate Professor of Surgery, Harvard School of Medicine; Consulting Staff, Department of Urological Surgery, Children's Hospital Boston

Marc Cendron, MD is a member of the following medical societies: American Academy of Pediatrics, American Urological Association, New Hampshire Medical Society, Societies for Pediatric Urology, Society for Fetal Urology, Johns Hopkins Medical and Surgical Association, European Society for Paediatric Urology

Disclosure: Nothing to disclose.

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