Intermittent testicular torsion in a 58-year-old man

A 26-Year-Old Male with a 14-Year History of Left Intermittent Testicular Torsion Treated with Self-Manual Reduction

Intermittent testicular torsion presents with recurrent episodes of severe unilateral testicular pain with resolution of symptoms between episodes. We present a case of a 26-year-old man with a 14-year history of intermittent testicular pain presenting to the urology clinic for elective surgical evaluation. He reported monthly symptoms for many years and had learned to manually reduce the torsion with each episode. Diagnosis of intermittent testicular torsion was made based on patient history and treatment with bilateral orchiopexy resulted in complete symptom resolution and without any loss of testicular function.

Intermittent Testicular Torsion in Adults: An Overlooked Clinical Condition

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.

Sonographic differential diagnosis of acute scrotum: real-time whirlpool sign, a key sign of torsion

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.