Testicular torsion

Testicular torsion is a superacute condition caused by the rotation of the testicle around the pedicle and strangulation of the supply arteries. When the blood vessels in the vas deferens are completely strangled, ischemia occurs and subsequent necrosis with partial infarction. In order for the testicle to be saved, the condition must be resolved within six hours of the onset of the problem. Torsion is caused by a strong contraction of the cremaster muscle.

Predisposes to torsion:
 * Longer and looser vascular pedicle,
 * cryptorchism,
 * wide tunica vaginalis,
 * long mesorchium,
 * weak suspension apparatus of the testis on the tunica dartos.

According to localization, we distinguish torsion:
 * extravaginal (the casings of the testis also rotate around the vas deferens – tunica vaginalis),
 * intravaginal (rotated only the testes inside the packages),
 * torsion of the mesorchy (strangulation of the hanging mesorchy).

Clinical picture
With testicular tension, there is a sudden, sharp pain in the testicle shooting into the groin, swelling and redness of the scrotum. They are not present (unlike epididymitis or orchitis) general symptoms such as fever, malaise, laboratory-detected increased inflammatory markers.

Diagnosis and differential diagnosis
It is important to differentiate this condition from orchitis (rule out parotitis), epididymitis, orchiepididymitis and testicular tumor. Diagnosis is based on history, physical examination, sonography (with Doppler probe) and diaphanoscopy.

Related articles

 * Acute scrotum
 * Testicles
 * Orchitis acuta
 * Cremaster