1
|
Dias AC, Cruz PRCD, Ribeiro PRF, Riccetto CLZ. Testicular volume and Tanner stage: determinant factors for testicular torsion. EINSTEIN-SAO PAULO 2022; 20:eAO6605. [PMID: 35476083 PMCID: PMC9000982 DOI: 10.31744/einstein_journal/2022ao6605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 07/12/2021] [Indexed: 11/30/2022] Open
Abstract
Objective To assess testicular volumes and sexual maturation in patients with testicular torsion. Methods A retrospective analysis of consecutively treated patients with testicular torsion between 2016 and 2018. Age, pubic hair staging (Tanner), and by ultrasonography, volume of the unaffected testis (in cubic centimeters) were evaluated either immediately before surgery or at the first postoperative visit. Patients with previous testicular disease, such as cryptorchidism, or with no records of testicular volume were excluded. The analysis included descriptive statistics and Bayesian regression. Results We treated 149 patients during the study period, and 141 (94.6%, median age 17.3 years) met the inclusion criteria. Median testicular volume was 13.0cm3 (interquartile range of 10.5-15.2), with similar right and left volumes (12.9cm3versus 13.3cm3; p=0.94). Sixty-five (46.1%) patients were Tanner stage IV, 17 (12.1%) stage III, and 59 (41.8%) stage V. Conclusion In this study, we were able to estimate volumes of testicular torsion, which aggregated around late puberty values (13.0cm3 for the whole dataset, 12.2cm3 for patients <25 years), suggesting that testicular hypermobility, due to congenital anatomical abnormalities, remains quiescent until the organ reaches a critical volume, after which torsion becomes possible. These findings provide a tentative explanation for the disease’s age distribution.
Collapse
|
2
|
The bell-clapper deformity of the testis: The definitive pathological anatomy. J Pediatr Surg 2021; 56:1405-1410. [PMID: 32762939 DOI: 10.1016/j.jpedsurg.2020.06.023] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 06/16/2020] [Indexed: 11/22/2022]
Abstract
INTRODUCTION The bell-clapper deformity (BCD) predisposes to intravaginal torsion (IVT) and is classically bilateral. The precise pathological definition of what constitutes a BCD is not clear. The current study aims to clarify the specific anatomic details of this anomaly. METHODS A systematic review was performed utilizing the PRISMA principles. Studies are presented chronologically based on their level of evidence. They are further divided into study types: autopsy and operative studies of acute torsion, intermittent torsion and studies of the contralateral testis in vanishing testis. RESULTS The bell-clapper deformity is best defined by complete investment of the testis, epididymis and a length of the spermatic cord by the tunica vaginalis. Based on autopsy studies the rate of BCD in scrotal testis varied from 4.9% to 16%; with bilaterality in 66%-100%. In cases of acute IVT bilaterality was noted in 54%-100%. The most disparate results were in cases of testicular regression syndrome where contralateral BCD was noted in 0%-87% of cases. CONCLUSION We suggest future studies employ the strict anatomical definition above. As there is evidence of age-dependent investment of the testes, it will be important to develop age-standardized measurements of intravaginal length of spermatic cord. This critical morphometric measurement will allow a better understanding of the risk of IVT. LEVEL OF EVIDENCE Systematic review of diagnostic studies: lowest level of evidence of included manuscripts Level IV (case-control studies with a poor reference standard).
Collapse
|
3
|
Al-Kandari AM, Kehinde EO, Khudair S, Ibrahim H, ElSheemy MS, Shokeir AA. Intermittent Testicular Torsion in Adults: An Overlooked Clinical Condition. Med Princ Pract 2017; 26:30-34. [PMID: 27648954 PMCID: PMC5588398 DOI: 10.1159/000450887] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 09/19/2016] [Indexed: 11/19/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Ahmed M. Al-Kandari
- Department of Surgery (Urology), Faculty of Medicine, Kuwait University, Kuwait City, Kuwait, Egypt
- *Ahmed M. Al-Kandari, Department of Surgery (Urology), Faculty of Medicine, Kuwait University, Jabryiah, 4th ring road, P.O. Box 24923, Safat 13110 (Kuwait), E-Mail
| | - Elijah O. Kehinde
- Department of Surgery (Urology), Faculty of Medicine, Kuwait University, Kuwait City, Kuwait, Egypt
| | - Salah Khudair
- Department of Surgery (Urology), Faculty of Medicine, Kuwait University, Kuwait City, Kuwait, Egypt
| | - Hamdy Ibrahim
- Department of Urology, Fayoum University, Fayoum, Egypt
| | | | | |
Collapse
|
4
|
|
5
|
Discharge summaries for patients undergoing acute scrotal exploration: Are we providing accurate essential information? JOURNAL OF CLINICAL UROLOGY 2016. [DOI: 10.1177/2051415815623124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: To investigate the accuracy of electronic discharge summaries (EDSs) written for patients who had undergone acute scrotal exploration for suspected testicular torsion. Methods: We reviewed the operation notes and EDSs for 169 admissions over a 52-month period where patients had undergone acute scrotal exploration for suspected acute testicular torsion and reviewed the correlation between what was written in these documents, focusing on laterality of pain, operative findings and procedure performed. Results: We found that the side of testicular pain was not mentioned in 14.8% of EDSs, the operative findings recorded on the EDS did not correlate to those on the operation notes in 17.2% of cases and the overall procedure performed did not correlate in 35.5% (with most of these relating to the laterality of the operation). The fact that an operative procedure happened at all was not mentioned in 4.7% ( n = 8) of the EDSs. Conclusions: The information in such an important medical document needs to be accurate, and we advocate that the person performing the operation should initiate the discharge summary process, where EDS use is the norm for discharge. Junior doctors entering urology departments must also be trained on the key information to be included in urological EDSs.
Collapse
|
6
|
Pozor M, Freeman D, Troedsson M, Brown M, Morton A, Smith A, McNaughten J. Anatomical variations in epididymal-testicular fusion in stallions and their possible clinical significance. Equine Vet J 2015; 48:490-5. [PMID: 26032404 DOI: 10.1111/evj.12464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Accepted: 05/26/2015] [Indexed: 11/27/2022]
Abstract
REASONS FOR PERFORMING STUDY Fusion anomalies of the epididymis with the testis may be clinically relevant in horses. However, anatomical variations in epididymal-testicular fusion have not been classified, and their clinical significance is unknown. OBJECTIVES To describe anatomical variations and clinical significance of epididymal-testicular fusion in stallions. STUDY DESIGN Anatomical study of testes from castrations, and description of 2 clinical cases with atypical epididymal-testicular fusion. METHODS A total of 104 testes were obtained from equine castrations. Eight patterns of epididymal-testicular fusion were identified. Two clinical cases with epididymal dislocation were also described. RESULTS Close attachment of the entire epididymis to the testis was the most common pattern of fusion (40%). Ninety-five per cent of cryptorchid testes and 34% of scrotal testes in the studied sample had elongated proper ligaments of the testes. Dislocation of the epididymal tail was observed in 2 stallions that had atypically long proper ligaments inserted on the dorsal aspect of the testes. CONCLUSIONS Patterns of epididymal-testicular fusion can vary in stallions. Elongated proper ligaments of the testes occur mostly in cryptorchid testes but are also found in stallions with scrotal testes. Epididymal dislocation may develop in stallions with long proper ligaments that are inserted dorsally on the testes.
Collapse
Affiliation(s)
- M Pozor
- Department of Large Animal Clinical Sciences, University of Florida College of Veterinary Medicine, Gainesville, USA
| | - D Freeman
- Department of Large Animal Clinical Sciences, University of Florida College of Veterinary Medicine, Gainesville, USA
| | - M Troedsson
- Department of Large Animal Clinical Sciences, University of Florida College of Veterinary Medicine, Gainesville, USA
| | - M Brown
- Department of Large Animal Clinical Sciences, University of Florida College of Veterinary Medicine, Gainesville, USA
| | - A Morton
- Department of Large Animal Clinical Sciences, University of Florida College of Veterinary Medicine, Gainesville, USA
| | - A Smith
- Department of Large Animal Clinical Sciences, University of Florida College of Veterinary Medicine, Gainesville, USA
| | - J McNaughten
- Department of Large Animal Clinical Sciences, University of Florida College of Veterinary Medicine, Gainesville, USA
| |
Collapse
|
7
|
Intermittent Testicular Torsion in the Pediatric Patient: Sonographic Indicators of a Difficult Diagnosis. AJR Am J Roentgenol 2013; 201:912-8. [DOI: 10.2214/ajr.12.9448] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
8
|
|
9
|
Klotz A, Moormann O. [Special pain conditions in urology. Summary, literature review and suggestions]. Urologe A 2009; 48:1170, 1172-4. [PMID: 19777203 DOI: 10.1007/s00120-009-2037-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The diagnosis of acute or chronic pain syndromes of the urogenital system can be verified and successfully treated by exact exploration of the patients medical history, the physical examination and a few image-guided or laboratory analyses Pain conditions which remain of unknown etiology even after extensive investigations are difficult to treat by the urologist alone. In cases where no causally determined morphological changes can be found or the alteration is disproportionate to the discomfort sensed by the patient, a multidisciplinary therapy strategy offers an approach to find a solution.
Collapse
Affiliation(s)
- A Klotz
- Paracelsus-Klinik Golzheim, Düsseldorf.
| | | |
Collapse
|
10
|
Hayn MH, Herz DB, Bellinger MF, Schneck FX. Intermittent Torsion of the Spermatic Cord Portends an Increased Risk of Acute Testicular Infarction. J Urol 2008; 180:1729-32. [DOI: 10.1016/j.juro.2008.03.101] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2007] [Indexed: 11/29/2022]
Affiliation(s)
- Matthew H. Hayn
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, and Division of Pediatric Urology, Dartmouth-Hitchcock Medical Center, Children's Hospital at Dartmouth (DBH), Lebanon, New Hampshire
| | - Daniel B. Herz
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, and Division of Pediatric Urology, Dartmouth-Hitchcock Medical Center, Children's Hospital at Dartmouth (DBH), Lebanon, New Hampshire
| | - Mark F. Bellinger
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, and Division of Pediatric Urology, Dartmouth-Hitchcock Medical Center, Children's Hospital at Dartmouth (DBH), Lebanon, New Hampshire
| | - Francis X. Schneck
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, and Division of Pediatric Urology, Dartmouth-Hitchcock Medical Center, Children's Hospital at Dartmouth (DBH), Lebanon, New Hampshire
| |
Collapse
|
11
|
Abstract
Testicular torsion is one of the common causes of acute scrotal pain. This review discusses the clinical and sonographic findings of intravaginal and extravaginal testicular torsion, including the normal sonographic and vascular anatomy of the testis. The role of color flow Doppler and spectral Doppler is also emphasized in the patient's complete, incomplete, and intermittent testicular torsion. Sonographic features of testicular torsion mimics, such as vasculitis, venous thrombosis, scrotal edema, and technical parameters, are also presented. A brief description of new developments such as contrast-enhanced ultrasound, dynamic contrast magnetic resonance imaging, and near-infrared imaging is included.
Collapse
Affiliation(s)
- E P Lin
- Department of Imaging Sciences, University of Rochester School of Medicine, Rochester, NY, USA
| | | | | | | |
Collapse
|
12
|
White WM, Brewer ME, Kim ED. Segmental ischemia of testis secondary to intermittent testicular torsion. Urology 2006; 68:670-1. [PMID: 16979700 DOI: 10.1016/j.urology.2006.04.024] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2006] [Revised: 03/10/2006] [Accepted: 04/25/2006] [Indexed: 12/01/2022]
Affiliation(s)
- Wesley M White
- Department of Urology, University of Tennessee Medical Center, Knoxville, Knoxville, Tennessee 37920, USA.
| | | | | |
Collapse
|
13
|
Vijayaraghavan SB. Sonographic differential diagnosis of acute scrotum: real-time whirlpool sign, a key sign of torsion. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2006; 25:563-74. [PMID: 16632779 DOI: 10.7863/jum.2006.25.5.563] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
OBJECTIVE The purpose of this study was to prospectively investigate the role of high-resolution and color Doppler sonography in the differential diagnosis of acute scrotum and testicular torsion in particular. METHODS Patients who underwent sonography for acute scrotum between April 2000 and September 2005 were included in the study. Gray scale and color Doppler sonography of the scrotum was performed. The spermatic cord was studied on longitudinal and transverse scans from the inguinal region up to the testis, and the whirlpool sign was looked for. RESULTS During this period, 221 patients underwent sonography for acute scrotum. Sixty-five had epididymo-orchitis with a straight spermatic cord, a swollen epididymis, testis, or both, an absent focal lesion in the testis, and increased flow on color Doppler studies along with the clinical features of infection. Three had testicular abscesses. Sonography revealed features of torsion of testicular appendages in 23 patients and acute idiopathic scrotal edema in 19. Complete torsion was seen in 61 patients who had the whirlpool sign on gray scale imaging and absent flow distal to the whirlpool. There was incomplete torsion in 4 patients in whom the whirlpool sign was seen on both gray scale and color Doppler imaging. Nine patients had segmental testicular infarction, and 1 had a torsion-detorsion sequence revealing testicular hyperemia. In 14 patients, the findings were equivocal. There was a complicated hydrocele, mumps orchitis, and vasculitis of Henoch-Schönlein purpura in 1 patient each. Five patients had normal findings. Fourteen were lost for follow-up. CONCLUSIONS Sonography of acute scrotum should include study of the spermatic cord. The sonographic real-time whirlpool sign is the most specific and sensitive sign of torsion, both complete and incomplete. Intermittent testicular torsion is a challenging clinical condition with a spectrum of clinical and sonographic features.
Collapse
|
14
|
|
15
|
Affiliation(s)
- Bryan I Johnston
- Division of Urology, Department of Surgery, University of Mississippi Medical Center, Jackson, Mississippi 39216, USA
| | | |
Collapse
|