Extravaginal testicular torsion: A clinical entity with unspecified surgical anatomy

Abstract

Purpose: To review and evaluate the anatomical definitions of perinatal extravaginal torsion (EVT) of the testis. Materials and Methods: An extensive review of the literature was made to reveal the prevalent anatomical background predisposing to EVT. Gross appearance of twisted testes obtained during surgery for 14 cases of EVT was used to test the validity of the above theories. Results: The most commonly accepted suggestions describe an EVT within dartos muscle that includes all layers of spermatic cord or an EVT outside parietal layer of tunica vaginalis within internal spermatic fascia. However, both of them were found inadequately documented, while a large volume of controversial data has been accumulated, that raises doubts regarding the validity of such definitions. The gross appearance of twisted testes failed to confirm both an EVT including all layers of the spermatic cord and also an EVT outside tunica vaginalis as possible mechanisms of torsion. Conclusion: The anatomical basis of EVT remains unclear and further investigation is required.