Testicular Torsion: Causes and Treatment

Testicular torsion – colloquially called testicular torsion – (synonyms: epididymal torsion; testicular torsion; epididymal torsion; spermatic cord torsion; testicular torsion; torsion of the ductus deferens; torsion of the funiculus spermaticus; ICD-10-GM N44.0: testicular torsion) is an acute reduced blood supply to the testis caused by the sudden rotation of the testis about its vascular pedicle.

Testicular torsion is an emergency!

It often occurs during sleep (50%), but also during sports.

The left testicle is torqued more often than the right testicle (about 6 0%: 40%). Testicular torsion can also occur bilaterally.

Special forms of testicular torsion are:

  • Intermittent testicular torsion: after acute pain symptoms, there is a rapid improvement in findings (Doppler sonography shows a hyperperfused testis).
  • Neonatal testicular torsion. The torsion event is usually prenatal (before birth); in about 100% of cases, there is a severely damaged testicular parenchyma (testicular tissue)

Frequency peak: usually children are affected. The maximum incidence is in the 1st year of life and puberty (14-16 years of age). Approximately 80% of cases of acute scrotum in adolescents are due to torsion of the testis (between 14-21 years even 90%) Cave (Warning)! An older age does not exclude testicular torsion. Testicular torsion can occur in the newborn to the adult.

The incidence (frequency of new cases) of testicular torsion in men younger than 25 years is approximately 1 case per 4,000 population per year.

Course and prognosis: Irreversible damage to the testicular parenchyma (testicular tissue) due to ischemia (reduced blood flow) occurs after only 4 hours! The ischemia time in infancy is a maximum of 6-8 hours; for newborns or infants, this period is even much shorter.