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- Twisting of testis and spermatic cord, resulting in acute ischemia and loss of testis if unrecognized:
- Intravaginal torsion: occurs within tunica vaginalis, only involves testis and spermatic cord
- Extravaginal torsion: involves twisting of testis, cord, and processus vaginalis as a unit; typically seen in neonates
- System(s) affected: reproductive
Rare in this age group
Etiology and Pathophysiology
- Twisting of spermatic cord causes venous obstruction, edema of testis, and arterial occlusion.
- “Bell clapper” deformity is most common anatomic anomaly predisposing to intravaginal torsion:
- No clear anatomic defect is associated with extravaginal testicular torsion:
- Usually spontaneous and idiopathic (1)[B]
- 20% of patients have a history of trauma.
- 1/3 have had prior episodic testicular pain.
- Contraction of cremaster muscle or dartos may play a role and is stimulated by trauma, exercise, cold, and sexual stimulation.
- Increased incidence may be due to increasing weight and size of testis during pubertal development.
- Possible alterations in testosterone levels during nocturnal sex response cycle; possible elevated testosterone levels in neonates (1)[B]
- Testis must have inadequate, incomplete, or absent fixation within scrotum (1)[B].
- Torsion may occur in either clockwise or counterclockwise direction.
- Familial testicular torsion, although previously rarely reported, may involve as many as 10% of patients.
- May be more common in winter
- Previous contralateral testicular torsion