Testicular Torsion in the Emergency Room: A Review of Detection and Management Strategies

Overview

Journal Open Access Emerg Med

Publisher Dove Medical Press

Specialty Emergency Medicine

Date 2020 Oct 29

PMID 33116959

Citations 12

Authors

Abdullah Laher

Shavania Ragavan

Puja Mehta

Ahmed Adam

Affiliations

Soon will be listed here.

Abstract

Testicular torsion is a challenging and time-sensitive diagnosis that is encountered frequently in daily practice, especially in the emergency room. A thorough history, the presence of a painful and swollen testis and testicular ultrasonography plays a vital role in the prompt diagnosis of testicular torsion. Prompt diagnosis is essential to prevent complications of testicular torsion which include testicular infarction, necrosis, and sub/infertility. This can be challenging as there are various other conditions that may mimic the presentation of testicular torsion. Since testicular torsion is an extremely time-sensitive diagnosis, it may also be a subject of many medicolegal challenges. This review article serves as a guide for clinicians involved with the diagnosis and management of testicular torsion. We review and discuss detection and management strategies based on their validity, statistical significance, and effectiveness in enabling prompt diagnosis and management of testicular torsion. Medicolegal implications of testicular torsion are also highlighted.

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References

Durmaz M, Sivri M . Comparison of superb micro-vascular imaging (SMI) and conventional Doppler imaging techniques for evaluating testicular blood flow. J Med Ultrason (2001). 2017; 45(3):443-452. DOI: 10.1007/s10396-017-0847-9. View

Cicek T, Togan T, Akbaba K, Narci H, Aygun C . The value of serum mean platelet volume in testicular torsion. J Int Med Res. 2015; 43(3):452-9. DOI: 10.1177/0300060514558898. View

Visser A, Heyns C . Testicular function after torsion of the spermatic cord. BJU Int. 2003; 92(3):200-3. DOI: 10.1046/j.1464-410x.2003.04307.x. View

Jansen R, Fooks H, Zaslau S . An atypical presentation of testicular torsion: a case report. W V Med J. 2013; 109(5):30-1. View

Cimador M, DiPace M, Castagnetti M, DeGrazia E . Predictors of testicular viability in testicular torsion. J Pediatr Urol. 2008; 3(5):387-90. DOI: 10.1016/j.jpurol.2007.01.194. View

Karmazyn B, Steinberg R, Kornreich L, Freud E, Grozovski S, Schwarz M . Clinical and sonographic criteria of acute scrotum in children: a retrospective study of 172 boys. Pediatr Radiol. 2004; 35(3):302-10. DOI: 10.1007/s00247-004-1347-9. View

Pentyala S, Lee J, Yalamanchili P, Vitkun S, Khan S . Testicular torsion: a review. J Low Genit Tract Dis. 2006; 5(1):38-47. DOI: 10.1046/j.1526-0976.2001.51008.x. View

Pogorelic Z, Mrklic I, Juric I, Biocic M, Furlan D . Testicular torsion in the inguinal canal in children. J Pediatr Urol. 2012; 9(6 Pt A):793-7. DOI: 10.1016/j.jpurol.2012.10.013. View

Srinivasan A, Freyle J, Gitlin J, Palmer L . Climatic conditions and the risk of testicular torsion in adolescent males. J Urol. 2007; 178(6):2585-8. DOI: 10.1016/j.juro.2007.08.049. View

10.

Arap M, Vicentini F, Cocuzza M, Hallak J, Athayde K, Lucon A . Late hormonal levels, semen parameters, and presence of antisperm antibodies in patients treated for testicular torsion. J Androl. 2007; 28(4):528-32. DOI: 10.2164/jandrol.106.002097. View

11.

Skoglund R, McRoberts J, RAGDE H . Torsion of testicular appendages: presentation of 43 new cases and a collective review. J Urol. 1970; 104(4):598-600. DOI: 10.1016/s0022-5347(17)61790-7. View

12.

Sheth K, Keays M, Grimsby G, Granberg C, Menon V, Dajusta D . Diagnosing Testicular Torsion before Urological Consultation and Imaging: Validation of the TWIST Score. J Urol. 2016; 195(6):1870-6. DOI: 10.1016/j.juro.2016.01.101. View

13.

Anderson J, Williamson R . Testicular torsion in Bristol: a 25-year review. Br J Surg. 1988; 75(10):988-92. DOI: 10.1002/bjs.1800751015. View

14.

Munden M, Williams J, Zhang W, Crowe J, Munden R, Cisek L . Intermittent testicular torsion in the pediatric patient: sonographic indicators of a difficult diagnosis. AJR Am J Roentgenol. 2013; 201(4):912-8. DOI: 10.2214/AJR.12.9448. View

15.

Korkes F, Cabral P, Alves C, Savioli M, Pompeo A . Testicular torsion and weather conditions: analysis of 21,289 cases in Brazil. Int Braz J Urol. 2012; 38(2):222-8. DOI: 10.1590/s1677-55382012000200010. View

16.

Cunningham R . Familial occurrence of testicular torsion. JAMA. 1960; 174:1330-1. DOI: 10.1001/jama.1960.63030100018026b. View

17.

Shteynshlyuger A, Yu J . Familial testicular torsion: a meta analysis suggests inheritance. J Pediatr Urol. 2012; 9(5):683-90. DOI: 10.1016/j.jpurol.2012.08.002. View

18.

Watkin N, Reiger N, Moisey C . Is the conservative management of the acute scrotum justified on clinical grounds?. Br J Urol. 1996; 78(4):623-7. DOI: 10.1046/j.1464-410x.1996.16321.x. View

19.

Boettcher M, Krebs T, Bergholz R, Wenke K, Aronson D, Reinshagen K . Clinical and sonographic features predict testicular torsion in children: a prospective study. BJU Int. 2013; 112(8):1201-6. DOI: 10.1111/bju.12229. View

20.

Mabogunje O . Testicular torsion and low relative humidity in a tropical country. Br Med J (Clin Res Ed). 1986; 292(6517):363-4. PMC: 1339345. DOI: 10.1136/bmj.292.6517.363. View