Testicular torsion denotes an urgent situation characterized by impaired blood supply to the testis due to torsion of the spermatic cord. Spermatogenetic cell damage is reversible only if the situation is managed within 6 hours.
This study evaluates the diagnostic and therapeutic considera-tions of 23 cases (age: 11 days to 25 years) evaluated for testicular torsion between 2004 and 2010. Admission was 4 hours to 14 days from the onset of the symptoms. Testis and appendix testis torsi-on was diagnosed in 20 and 3 patients, respectively. When patients were assessed according to the presence or absence of intermittent testicular torsion (ITT) symptoms, the ones that had ITT had signi-ficantly longer times from the onset of symptoms to emergency ad-mission, and significantly higher rates of orchiectomy (63% versus 44%). Surgical detorsion and salvage was possible in 2 of these cases who were operated at 36th hour due to incomplete torsion. Etiology for orchiectomy in order of frequency were: late admission, delay in the management due to prior misdiagnoses, and time-wasting in patients referred for doppler ultrasound examination.
In conclusion, accurate management of testicular torsion ne-cessitates public education as well as avoidance of physicians from delayed ischemia times, and adoption of immediate surgery in situ-ations where emergency imaging modalities are not available. Pa-tients with a history of intermittent symptoms suggestive of ITT should be assessed more carefully, and considered for elective tes-ticular fixation.
Key Words: Testicular torsion, diagnosis, early management, problems
Abstract
Testicular torsion denotes an urgent situation characterized by impaired blood supply to the testis due to torsion of the spermatic cord. Spermatogenetic cell damage is reversible only if the situation is managed within 6 hours.
This study evaluates the diagnostic and therapeutic considera-tions of 23 cases (age: 11 days to 25 years) evaluated for testicular torsion between 2004 and 2010. Admission was 4 hours to 14 days from the onset of the symptoms. Testis and appendix testis torsi-on was diagnosed in 20 and 3 patients, respectively. When patients were assessed according to the presence or absence of intermittent testicular torsion (ITT) symptoms, the ones that had ITT had signi-ficantly longer times from the onset of symptoms to emergency ad-mission, and significantly higher rates of orchiectomy (63% versus 44%). Surgical detorsion and salvage was possible in 2 of these cases who were operated at 36th hour due to incomplete torsion. Etiology for orchiectomy in order of frequency were: late admission, delay in the management due to prior misdiagnoses, and time-wasting in patients referred for doppler ultrasound examination.
In conclusion, accurate management of testicular torsion ne-cessitates public education as well as avoidance of physicians from delayed ischemia times, and adoption of immediate surgery in situ-ations where emergency imaging modalities are not available. Pa-tients with a history of intermittent symptoms suggestive of ITT should be assessed more carefully, and considered for elective tes-ticular fixation.
Key Words: Testicular torsion, diagnosis, early management, problems