Testicular Torsion Diagram
A testicular torsion diagram is useful in identifying a torsion pattern in a testis. It helps identify the types of torsion in testis and spermatic cord. In the diagram, the spermatic cord is twisted around the testis and is described as an “A” shape. Other torsion patterns include: Horizontal, Lateral, and Intermittent.
Anterior
Anterior testicular torsion is caused by the torsion of the testicles. During a physical examination, the testis looks almost diagonally oriented. Testicular torsions can vary in severity. Many cases will be mild to moderate, with a small percent suffering from a more severe torsion. In a patient who is experiencing intermittent testicular torsion, manual manipulation can reduce the torsion.
The early diagnosis of testicular torsion is crucial in the treatment of the disease. The earliest diagnosis allows for effective surgical detorsion. The symptoms of testicular torsion can include pain, swelling, and necrosis. If the condition is not detected early, it may result in subfertility and even infertility.
Lateral
Testicular torsion is a condition in which the testes rotate in either a medial or lateral direction, toward the thigh. One-third of testes are torsed in this way. It usually occurs below the inguinal canal. It is more common in neonates.
The point of torsion is often indistinct. When this condition presents without symptoms, it can be mistaken for epididymo-orchitis. Although the point of torsion is usually not discernible, high-resolution sonography can help to identify the cause and recommend surgical management. The length and degree of torsion can also be determined using this imaging technique.
Manual detorsion may be an effective treatment option. It involves rotating the torn testicle through two planes. In the first attempt, the testicle should be rotated caudal to cranial to release the locking mechanism and then subsequently rotated lateral to medial to effect detorsion of the spermatic cord. The number of rotations needed will vary, but as many as 1080 horizontal degrees may be required in some cases.
Intermittent
Intermittent testicular torsion (ITT) is a complication of testicular pain that recurs between episodes of symptomatic relief. It is important to treat it early to prevent recurrences and improve the chances of preserving testicular function. In this case study, a 26-year-old man underwent bilateral orchiopexy for symptomatic ITT. He had been experiencing symptoms on and off for many years. After learning how to manually reduce the torsion between episodes, he underwent bilateral orchiopexy. After recovery, he reported no loss of testicular function.
If left untreated, testicular torsion may result in acute torsion, testicular ischemia, or even testicular loss. In some cases, a manual detorsion procedure may be necessary to restore blood flow to the affected testicle. During this procedure, the physician will place his fingers on the affected testicle and rotate it away from the midline by 180 degrees. Ultimately, this method can provide dramatic pain relief.
Horizontal
The diagnosis of testicular torsion is often uncertain. The time period after the torsion occurs is often regarded as the window for possible salvage. However, studies indicate that the survival rates are higher at 24 hours. The intermittent nature of testicular torsion makes it difficult to predict the exact onset of irreversible ischemia. Because of this, treatment decisions should not be based on the length of the torsion. It is imperative to treat any suspected testicular torsion as an emergency.
Testicular torsion can occur in either a neonate or an adult. In the former case, the testis is twisted inside the tunica vaginal. The result is that the testis may be turned away from the spermatic cord.
Oblique
Oblique testicular torsion is an acute, unilateral pain experienced by a 17-year-old male following a football game. He has had six to seven episodes of the same type in the past two years. His symptoms were sudden, accompanied by an elevated right testis and no cremasteric reflex. On transverse US, his right testis is echogenic with an edematous spermatic cord and faces medially instead of posterolaterally.
During initial examination, immediate manual detorsion may be attempted. During detorsion, the testis rotates outward. Generally, it rotates clockwise when seen from the front. It may require more than one rotation to eliminate the torsion. The procedure is guided by the patient’s pain and the extent of the torsion.
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