Testicular Torsion

Abstract

Testicular torsion is the most common genitourinary emergency in childhood with an estimated incidence of 3.5-4.5 per 100.000 males younger than 25 years attending the hospital every year (Mansbach et al., Arch Pediatr Adolesc Med, 159:1167-1171, 2005; Huang et al., Acta Paediatr, 102:e363-7, 2013). Testicular torsion can be classified according to the mechanism of torsion into extravaginal or intravaginal, while clinically these can be further differentiated in perinatal torsion, which include prenatal and postnatal, and torsion beyond the neonatal period (Fig. 1). An accurate history and physical examination play a major role in the diagnosis of patients with acute scrotum complemented by, in complex cases, imaging modalities, which can aid to make a diagnosis and to predict the chance of testicular salvage with high sensitivity and specificity. Among pediatric urologists, there is no clear consensus in the management of neonatal testicular torsion, with strategies ranging from observation alone of possible acute changes in the contralateral testis, to emergency or elective surgical exploration, while postnatal torsion as well as torsion in adolescents are treated by emergency exploration. Testicular torsion is a common cause of litigation all over the world, which leads to an orchiectomy in 31-69% of cases. A prompt diagnosis and treatment are therefore required to avoid ischemic damage to the testis.