Torsion Of Testis / Testicular Torsion

It is the torsion of the spermatic cord structures and subsequent loss of the blood supply to the ipsilateral testicle.

This is a urological emergency

Causes Of Testicular Torsion

  1. Physical activity
  2. Injury to the scrotum
  3. Cold temperatures
  4. Rapid growth of testis during puberty
  5. Straining during defecation 
  6. Coitus
  7. During sleep 

Management Of Torsion Of Testis


  1. Age 10 – 25 years
  2. Sudden agonizing pain in groin and lower abdomen
  3. Nausea and vomiting
  4. Swelling of the scrotum
  1. Mild pyrexia
  2. Redness of the overlying skin 
  3. Extreme tenderness of the testis
  4. High riding of the testis
  5. Elevation of the testis make the pain worse
  6. Abnormal angle of the testis (Transverse)
  7. Tender, twisted and thickened cord
  8. Loss of cremasteric reflex 
  • Usually no investigations are needed
  • Clinical diagnosis is done
  • If any uncertainty – Doppler ultrasonography
  1. Surgical exploration 
    • If viable – 3 point fixation 
    • If non viable – Orchidectomy 
Complications Of Torsion Of Testis
  1. Testicular infarction 
  2. Scrotal abscess
  3. Gangrene of the testes
  4. Necrosis 
  5. Recurrence 
Difference Between Testicular Torsion And Acute Epididymo-orchitis
Torsion Of Testis
Acute Epididymo-orchitis
1. Age Young age Any age
2. Onset Sudden Gradual
3. History of staining Present Absent
4. History of UTI Absent Present
1. Signs of inflammation Absent unless gangrene Present
2. Position of testis High up Normal
3. Effect of elevation Aggregates of pain Relieves pain
4. Site Unilateral May be bilateral
5. Fever Absent unless gangrene Present
1. Leukocytosis Absent unless gangrene Present
Treatment Surgical Conservative
Contents Of Spermatic Cord
  1.  Arteries
    • Testicular artery
    • Deferential artery
    • Cremasteric artery
  2. Nerves
    • Nerve to cremaster
    • Testicular nerves 
  3. Vas deferens (ductus deferens)
  4. Pampiniform plexus
  5. Lymphatic vessels
  6. Tunica vaginalis (remains of the processus vaginalis)
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