Intermittent Testicular Torsion Research Articles

Intermittent Testicular Torsion in an African Adult Patient: Sonographic Doppler findings of an uncommon and challenging diagnosis

Testicular torsion is a well known urological emergency most common in the paediatric population. However, testicular torsion can be complete, partial or intermittent. Intermittent testicular torsion is rare in adults and difficult to diagnose. We present a rare case on intermittent testicular torsion in a 35 year old man that was initially misdiagnosed but was later diagnosed by Spectral Doppler ultrasound.

Intermittent Testicular Torsion in an African Adult Patient: Sonographic Doppler findings of an uncommon and challenging diagnosis

Testicular torsion is a well known urological emergency most common in the paediatric population. However, testicular torsion can be complete, partial or intermittent. Intermittent testicular torsion is rare in adults and difficult to diagnose. We present a rare case on intermittent testicular torsion in a 35 year old man that was initially misdiagnosed but was later diagnosed by Spectral Doppler ultrasound.

Intermittent Testicular Torsion in an African Adult Patient - Sonographic Doppler findings an uncommon and challenging diagnosis

Testicular torsion is a well-known urological emergency most common in the paediatric population; however, testicular torsion is not all-or-none phenomenon and can be of complete or partial or intermittent types. Intermittent testicular torsion is rare and can be misdiagnosed even in a paediatric population. Testicular torsion in adults is less common and intermittent Testicular torsion in adults is even less reported and may not be considered in the differential diagnosis of acute Testicular pain, leading to misdiagnosis.

Intermittent Testicular Torsion in an African Adult Patient - Sonographic Doppler findings an uncommon and challenging diagnosis

Testicular torsion is a well-known urological emergency most common in the paediatric population; however, testicular torsion is not all-or-none phenomenon and can be of complete or partial or intermittent types. Intermittent testicular torsion is rare and can be misdiagnosed even in a paediatric population. Testicular torsion in adults is less common and intermittent Testicular torsion in adults is even less reported and may not be considered in the differential diagnosis of acute Testicular pain, leading to misdiagnosis.

Intermittent testicular torsion diagnosed by evaluating the rotatability of testis with ultrasonography: a case report

Intermittent testicular torsion diagnosed by evaluating the rotatability of testis with ultrasonography: a case report

Oral 29 - Bilateral Orchidopexy for men with intermittent testicular torsion – a single-surgeon prospective study

Oral 29 - Bilateral Orchidopexy for men with intermittent testicular torsion – a single-surgeon prospective study

Case of intermittent testicular torsion and de-torsion captured on scrotal ultrasound.

Case of intermittent testicular torsion and de-torsion captured on scrotal ultrasound.

Ultrasound whirlpool sign in intermittent testicular torsion: Presentation of two cases

Case description: The two cases were characterized by multiple episodes of very intense pain that resolved spontaneously. Testicular ultrasound was carried out in both cases, during an acute episode of pain. The Whirlpool sign was identified, together with vascular compromise of the testis, suggesting intermittent testicular torsion that required surgical treatment.
 Relevance: The aim of our report was to describe how intermittent testicular torsion is an uncommon pathology that should be suspected in young patients presenting with episodes of intense pain. Diagnostic ultrasound should be performed during an episode of pain.
 Clinical implications: Due to vascular compromise in the testis, opportune diagnosis is important. It begins with diagnostic suspicion that is supported by the patient’s clinical manifestations and proceeds to early bilateral testicular fixation, preventing necrosis of the testis.
 Conclusions: Intermittent testicular torsion is rare and difficult to diagnose. Prompt identification of the whirlpool sign during an acute episode of pain is essential for making the diagnosis and preventing the loss of the testis, which could result from underestimating subsequent episodes of pain.

Signo ecográfico del remolino en torsión testicular intermitente, presentación de 2 casos

Descripción del caso: Se presentan dos casos caracterizados por múltiples episodios de dolor muy intenso que se resolvían de manera espontánea. En ambos casos se realizó un ultrasonido testicular mientras persistía el cuadro agudo, en donde se identificó el signo del remolino junto con compromiso vascular del testículo sugerente de torsión testicular intermitente, que ameritó tratamiento quirúrgico.
 Relevancia: El objetivo es señalar que la torsión testicular intermitente es un padecimiento infrecuente que se debe de sospechar en pacientes jóvenes con episodios de dolor intenso en los que se debe de insistir en el ultrasonido en el episodio para el diagnóstico.
 Implicaciones clínicas: Debido al compromiso vascular en el testículo, es necesario realizar un diagnóstico oportuno que debe iniciar con una sospecha diagnóstica apoyada por las manifestaciones clínicas del paciente para proceder a la fijación testicular bilateral temprana y que el testículo no culmine en necrosis.
 Conclusiones: La torsión testicular intermitente es rara y de difícil diagnóstico, por lo que encontrar el signo del remolino en el episodio agudo con prontitud en los cuadros de dolor es esencial para el diagnóstico y prevenir la pérdida de la gónada por el menosprecio del dolor de repetición.

Testicular torsion: a scrotal catastrophe

Testicular torsion is a serious scrotal emergency having a negative impact on fertility and in its most severe presentation, there is potential loss of the testicle if not diagnosed early. The condition needs to be diagnosed promptly with immediate surgical intervention. Intermittent testicular torsion (ITT) is a forerunner or a red flag for an impending frank testicular torsion. ITT is characterized by sudden onset of testicular pain which may resolve spontaneously before further investigation and treatment. Testicular torsion in adults is usually intravaginal in location and can be diagnosed clinically if the patient presents early with typical clinical signs. A case of ITT who presented with frank unilateral testicular torsion diagnosed clinically and surgically treated with salvage of the affected testes is presented to highlight the importance of history of ITT and typical clinical features. The anatomical aspects and pathophysiology of testicular torsion including the aftermath is discussed. ITT is a forerunner to frank testicular torsion. If offered prophylactic orchidopexy then a frank episode of testicular torsion with all its sequelae can be averted.

Acute Testicular Torsion: Presentation and Diagnosis

Testicular torsion is the most common pediatric urologic emergency and is a common cause of acute scrotal pain. Timely diagnosis is important for testicular salvage,as treatment delayed beyond 6 hours from the onset of symptoms is the most predictive factor of testicular death. There is a bimodal distribution of age with extravaginal torsion most commonly presenting in the neonatal period and intravaginal torsion most commonly presenting around the onset of puberty. Intermittent testicular torsion presents a unique challenge in making an accurate diagnosis, as patients most often present when asymptomatic. Several risk factors exist, although bell-clapper deformity is the most important. The diagnosis is made largely on history or physical examination. In equivocal cases, imaging with color Doppler ultrasonography may be helpful in making the diagnosis. Additional tools including near-infrared spectroscopy and Testicular Workup for Ischemia and Suspected Torsion score may be helpful in diagnosing testicular torsion. Possible long-term effects on fertility and hormonal function are also often a concern for the patient and clinician. This review contains 6 figures, 5 tables, and 34 references. Keywords: acute, infarction, ischemia, orchidopexy, scrotum, spermatic cord, testis, torsion

Polyorchidism with intermittent testicular torsion

Polyorchidism with intermittent testicular torsion

Direction of Rotation in Testicular Torsion and Identification of Predictors of Testicular Salvage

To identify the rate at which testicular torsion occurs in a lateral direction and identify any predictors of direction of testicular rotation and orchiectomy. We performed a retrospective review of 104 cases of emergent scrotal exploration performed for testicular torsion by 3 pediatric urologists from 2003 to 2017. Patients with neonatal torsion, negative scrotal exploration, or exploration for presumed intermittent testicular torsion were excluded. Univariable logistic regression was performed to assess if any factors predicted direction of testicular rotation. Univariable and multivariable logistic regression was used to identify predictors of testicular salvage. Of 104 cases of acute testicular torsion, information regarding the direction of testicular rotation was available in 81 patients. Lateral testicular rotation occurred in 38 cases (46%). No factors were found to be predictive of direction of torsion. Orchiectomy for testicular nonviability was performed in 50 of 104 cases (48%). On univariable analysis, younger age (p = .002), absence of gastrointestinal symptoms (P = .02), time to exploration (P < .001), testicular size differential on ultrasound (p = .002), absence of hydrocele (P = .01), abnormal ultrasound echotexture (P < .001), and degree of torsion (P = .04) were associated with orchiectomy. With the exception of absence of gastrointestinal symptoms, all predictors of orchiectomy remained statistically significant on multivariable analysis. Testicular rotation occurs in a lateral direction in 46% of cases. Lateral manual detorsion should be performed only with awareness of the potential for increasing the degree of testicular rotation. New independent predictors of testicular salvage were identified.

Intermittent testicular torsion.

The aim of this study is to highlight the clinical characteristics of patients with intermittent testicular torsion and draw attention to this underreported condition. Clinical and demographic data of all patients treated for intermittent testicular torsion from January 2007 to June 2015 were prospectively collected in a pro forma and analyzed. A diagnosis of intermittent torsion was made on the basis of recurrent scrotal pain, presence of abnormal testicular lie in otherwise normal testes, absence of urinary symptoms, and negative urine cultures. This diagnosis was confirmed by resolution of symptoms following bilateral orchidopexy. All patients had bilateral orchidopexy at the next operative day and were followed up for 12 months. Forty-five patients with a mean age of 20.9 years (±4.02) were seen within the study period. The left testis was more often involved than the right: 53.3% versus 37.8%. The condition was bilateral in 4 patients (8.9%). A total of 84 testes were evaluated. Horizontal lie was the most common anomaly causing intermittent testicular torsion 49%, followed by the clapper-bell deformity 27.5%. Patients experienced a mean of 2.8 (±1.74) acute pain episodes before testicular fixation. Bilateral orchidopexy resulted in resolution of symptoms and preservation of testicular volume. Horizontal lie of the testis is the most common cause of intermittent testicular torsion. The condition is more common on the left than the right testis and is predominantly unilateral. Intermittent testicular pain in the presence of abnormal testicular lie should warrant a diagnosis of intermittent testicular torsion. Early bilateral orchidopexy is efficacious.

Intermittent Testicular Torsion in Adults: An Overlooked Clinical Condition

Objectives: The aim of this study was to describe the management protocol for intermittent testicular torsion (ITT) in adults and report the outcome of this clinical condition, which is commonly overlooked in adults. Subjects and Methods: Sixty-three patients were included in the study. The inclusion criterion was the presence of sudden intermittent testicular pain over a duration of 3 months. All the patients underwent clinical examination, urine analysis, culture, and scrotal ultrasound with Doppler. The testicle was in an abnormal or in transverse lie and/or could easily be twisted. Scrotal support and analgesia were given for 1 month, then patients were offered orchidopexy or conservative treatment. Nineteen patients chose orchidopexy while 44 chose conservative treatment. Follow-up ranged from 3 months to 2 years. The improvement was assessed using a visual analog pain score. The outcome of the treatment was compared between the surgical and conservative groups using a χ² test. Results: The median age of the patients was 28 years (range: 17-50). Of the 19 patients who underwent orchidopexy, the pain resolved or visual analog pain scores improved (median 1/10) in 18 (94.7%) cases. On the other hand, 21 of the 44 (47.7%) cases that chose the conservative approach claimed their pain resolved or improved (visual analog pain scores: median 3/10) with a median of 13 months of follow-up. Conclusion: In this study, scrotal orchidopexy proved to be superior to conservative measures in cases of ITT in adults.

Acute and intermittent testicular torsion: Analysis of presentation, management, and outcome in South East, Nigeria.

Testicular torsion compromises the blood supply to the testes and may result in testicular loss or damage if not dealt with promptly. It can occur either as acute testicular torsion (ATT) or intermittent testicular torsion (ITT). This study examines the presentation, management, and outcome of adult testicular torsion. During the period January 1999 and December 2009, 34 out of 59 patients treated for testicular torsion, who had complete records, were evaluated. Operating theater and urology ward admission registers were used to identify patients. Age range was 16-50 years. Of the 34 patients, 11 (32.4%) were between 26 and 30 years old, while 16 (47.1%) were between 16 and 25 years old. Mean age was 27 years. Scrotal pain of varying severity was noted in all patients; there was associated vomiting in 21% of cases and abdominal pain in 38% of cases. Clinical diagnosis was ATT in 12 (35.3%) patients and ITT in 22 (64.7%) patients. In the ATT group, only one patient (8.3%) presented within 6 h of onset of symptoms. In the ITT group, 3 patients (13.6%) presented within 1 month of onset of symptoms while 7 (31.8%) of patients presented between 1 and 6 months after the onset of symptoms. Testicular salvage rate was 58.3% for ATT. Surgical intervention occurred within 3 h in the ATT group in 7 patients (58.3%) and in 5 patients (41.7%) within 3-6 h of onset of symptoms. In the patients with ITT, 12 patients (54.5%) were operated upon within 1 month of presentation. Preoperative external manual detorsion was performed in 1 patient. Late presentation was observed, especially in the intermittent variety. Delay occurred both at pre- and intra-hospital phases. Testicular salvage rate may be improved by physician/health worker and community enlightenment. Adoption of local anesthetic may reduce intrahospital delay.

Intermittent testicular torsion in 13-year boy

A clinical case of intermittent spermatic cord torsion demonstrates the difficulty of diagnosis of this rare disease. The patient have suffered 2 episodes of intermittent spermatic cord torsion which was interpreted as epididymitis and appendage torsion. Orchiopexy made only after the third episode, when the clinical diagnostic signs consistent with acute spermatic cord torsion. All cases of a recurring acute pain in the testicle require in-depth analysis because even a single episode of scrotal pain indicates ischemia of testicle with possible atrophy in the future.

Chronic orchalgia after surgical exploration for acute scrotal pain in children

The aim was to review the pediatric cohort undergoing surgical exploration for acute scrotal pain at our institution and assess the entity of chronic orchalgia post exploration in this cohort. A retrospective review of all pediatric patients who underwent surgery for acute scrotal pain at a single institution between 1 January 2001 and 1 January 2012 was conducted. A total of 1084 patients underwent scrotal exploration for acute scrotal pain where the underlying cause could not be clinically ascertained. Causes found at exploratory surgery are shown in the table. Forty-four children (4.1%) re-presented with another episode of acute scrotal pain and underwent re-exploration. A hundred of the 772 children with testicular appendage torsion at initial exploration had unilateral exploration only. Seven (7%) of these re-presented with contralateral appendage torsion. The complication rate of initial scrotal exploration was 5.6% and that of re-exploration was 6.8%. All complications were managed conservatively except for a painful reactive hydrocele that underwent the Jaboulay procedure. Fifteen (1.4%) children in this cohort developed chronic orchalgia. Thirteen (87%) of these had definite pathology found at initial exploration. One of 61 (2%) with postoperative complications (a reactive hydrocele) developed chronic orchalgia. Pediatric chronic pain specialists were consulted for all patients. In 10 of the 15 (67%), significant comorbidities included constipation, anxiety, somatization, hydrocele, dysfunctional voiding, and multiple joint pain. The Jaboulay procedure for reactive hydrocele and re-exploration to pex the testes due to suspected intermittent testicular torsion resolved chronic orchalgia in one patient each. Pediatric chronic orchalgia post exploration is uncommon. It has a multifactorial etiology. Comorbidities are common. It is possible that some unexplored patients labeled as chronic orchalgia in the literature may have underlying correctable pathology. Surgically correctable pathology such as intermittent testicular torsion, metachronous testicular appendage torsion, and symptomatic hydrocele or varicocele should be excluded in children with chronic orchalgia. Chronic pain specialists should be consulted and associated comorbidities managed. Prior surgical exploration and testicular fixation in children with chronic orchalgia helped reassure patients and families that there was no underlying surgical cause for the pain and facilitated compliance with chronic pain management. Pediatric chronic orchalgia has a multifactorial etiology and is uncommon after scrotal exploration surgery. Comorbidities are common and must be managed. Surgical exploration helps reassure patients that there is no correctable cause for the pain and facilitates engagement with chronic pain management.

The "whirlpool sign", a US finding in partial torsion of the spermatic cord: 4 cases.

The "whirlpool sign", a US finding in partial torsion of the spermatic cord: 4 cases.

Epididymal polar dissociation: a previously undescribed anatomical variant.

The normal male external genitalia include the testicles with the epididymis attached posteriorly and the vas deferens arising from this. This case describes an anatomical variation of this normal anatomy not previously reported in the literature. A 17-year-old boy presented with symptoms of intermittent testicular torsion and underwent scrotal exploration. On the left side there was a bell-clapper deformity with the epididymis separated into two parts with the lower pole high in the scrotum and attached to the tunica vaginalis. A normal vas deferens was seen to arise from the isolated lower pole of the epididymis. There was no connection between the vas deferens and the testis or upper pole of epidiymis. This case reminds us of the possibility of anatomical variations and the importance of keeping them in mind to prevent complications at time of surgery.