Spiral twist of the spermatic cord: A reliable sign of testicular torsion

The children presenting with acute scrotum have many diseases in differential diagnosis and testicular torsion in undescended testis and normal testis is an important consideration. Torsion of the testis, or more correctly, torsion of the spermatic cord, is a surgical emergency because it causes strangulation of gonadal blood supply with subsequent testicular necrosis and atrophy. In most of cases history and physical examination are sufficient to make an accurate diagnosis. While other causes may require simple treatment but torsion require immediate exploration to save the testis. Early diagnosis and prompt treatment is essential to help such children.

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Diagnostic Accuracy of Ultrasound for the Directionality of Testicular Rotation and the Degree of Spermatic Cord Twist in Pediatric Patients With Testicular Torsion

Journal of Ultrasound in Medicine ◽

10.1002/jum.15084 ◽

2019 ◽

Vol 39 (1) ◽

pp. 119-126 ◽

Cited By ~ 2

Author(s):

Takahiro Hosokawa ◽

Hiroaki Takahashi ◽

Yutaka Tanami ◽

Yumiko Sato ◽

Tetsuya Ishimaru ◽

...

Keyword(s):

Diagnostic Accuracy ◽

Spermatic Cord ◽

Testicular Torsion ◽

Pediatric Patients

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L-Alanyl-Glutamine dipeptide pretreatment attenuates ischemia-reperfusion injury in rat testis

Acta Cirurgica Brasileira ◽

10.1590/s0102-86502011000700005 ◽

2011 ◽

Vol 26 (suppl 1) ◽

pp. 21-25 ◽

Cited By ~ 3

Author(s):

João Paulo de Vasconcelos Leitão ◽

Jefferson Menezes Viana Santos ◽

Raquel Cavalcante de Vasconcelos ◽

José Huygens Parente Garcia ◽

Paulo Roberto Leitão de Vasconcelos ◽

...

Keyword(s):

Spermatic Cord ◽

Testicular Torsion ◽

Ischemia Reperfusion Injury ◽

Reduced Glutathione ◽

Ischemia Reperfusion ◽

Time Points ◽

Rat Testis ◽

Pre Treatment ◽

The Right ◽

Time Point

PURPOSE: To investigate the effect of alanyl-glutamine dipeptide (L-Ala-Gln) pre-treatment on ischemia-reperfusion (I/R) injury after unilateral testicular torsion-detorsion in a comparative controlled experiment. METHODS: Forty-eight rats (150-200 g) randomly distributed into 4 groups (n=12), and distributed in 2 subgroups (n=6) each, were treated with saline 2.0 ml (G-1, G-3) or L-Ala-Gln 20%, 0.75g/kg dissolved in saline (total volume 2.0 ml) administered in the left saphenous vein 30 minutes before ischemia. Anesthetized rats were subjected to I/R induced by torsion (720°) of the right spermatic cord lasting 1h (G-1, G-2) or 3 hours (G-3, G4). Anesthesia was again applied at the end of ischemia time (T-0) for testis detorsion and 6 hours later (T-6) for orchiectomy. All operations were performed on the right testes through transverse scrotal incisions. Right orchiectomy was carried out at the end of ischemia (T-0), and 6 hours later (T-6) to evaluate the concentrations of malondialdehyde (MDA) and reduced glutathione (GSH) in the testis. RESULTS: Pretreatment with L-Ala-Gln reduced MDA contents in rat testis at the end of ischemia lasting 3 hours. There was significant increase of GSH levels in T-6 time-point after 1 hour of ischemia. GSH levels also increased in T-0 and T-6 time-points in rats subjected to ischemia for 3 hours. CONCLUSION: L-Ala-Gln administered before torsion/detorsion of the spermatic cord decreases lipid peroxidation during ischemia and protects the testis from oxidative stress by upregulating GSH levels during reperfusion.

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Ultrasonography of the spermatic cord in testicular torsion

European Journal of Radiology ◽

10.1016/0720-048x(94)90339-5 ◽

1994 ◽

Vol 18 (3) ◽

pp. 220-223 ◽

Cited By ~ 7

Author(s):

R. van Dijk ◽

H.F.M. Karthaus

Keyword(s):

Spermatic Cord ◽

Testicular Torsion

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Oligoasthenoteratozoospermia After Trial of Testicular Salvaging Surgery in Testicular Torsion: A Case Report

Green Medical Journal ◽

10.33096/gmj.v2i3.64 ◽

2020 ◽

Vol 2 (3) ◽

pp. 130-138

Author(s):

Muhammad Ainul Mahfuz ◽

Suwanto ◽

Muhammad Sidharta Krisna

Keyword(s):

Clinical Judgment ◽

Spermatic Cord ◽

Testicular Torsion ◽

Salvage Surgery ◽

Sperm Parameters ◽

Testicular Atrophy ◽

Sperm Analysis ◽

Fertility Status ◽

The Right ◽

Patients Experience

Testicular torsion (TT) is an emergency in urology that happens because of the spermatic cord’s rotation. Decreased of overall sperm parameters after TT often happens in which can endanger the patient’s fertility status. Approach on how to salvage the testicle and to prevent unwanted complications remains as the doctor’s greatest priority. We report a case of oligoasthenoteratozoospermia after surgical detorsion without orchidectomy in testicular torsion. A 19-year-old male, presenting with sudden, progressive, and continuous pain in the right testicle for 4 hours. The right testicle was larger in volume on physical examination, there were a negative phren sign and negative cremasteric reflex. Gray scale ultrasound without Doppler showed changes suggestive of testicular torsion. Emergency surgery revealed a dark-bluish right testicle with a 360o rotation of the spermatic cord. Detorsion without orchidectomy was performed with clinical judgment hoping for the restoration of testicular viability. Sperm analysis was done after one month and oligoasthenoteratozoospermia was found. Although some patients experience decreased overall sperm parameters after TT that perhaps making them infertile, interestingly there is no difference in pregnancy rates among couples with TT men when compared to the general population. The best testicular salvage surgery method to prevent testicular atrophy also has not been determined yet. Thus, the patient should be carefully counseled about the good outcome of pregnancy rate and the chance for testicular atrophy, regardless of what is the surgical choice.

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Color-Doppler sonography sensitivity of the spermatic cord in the diagnosis of acute testicular torsion

Urologia Journal ◽

10.1177/039156039806500129 ◽

1998 ◽

Vol 65 (1) ◽

pp. 118-119

Author(s):

M. Rizzo ◽

A. Di Girolamo ◽

M. Caramia ◽

E. Caldarera ◽

G. Randazzo ◽

...

Keyword(s):

Spermatic Cord ◽

Testicular Torsion ◽

Doppler Sonography ◽

Color Doppler ◽

Arterial Flow ◽

Color Doppler Sonography

In the period between 1994–96, 16 patients with suspected testicular torsion confirmed during operation, underwent color-Doppler sonography of the spermatic cord after local objective examination. The sonography showed a reduced or absent arterial flow in 15 patients and an increase in flow in 1 patient. In our study, color-Doppler sonography proved to have a sensitivity of 93.7%.

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The whirlpool sign predicts cases of testicular torsion with the preserved flow: a case series

10.21203/rs.3.rs-42065/v1 ◽

2020 ◽

Author(s):

Zhihua Xu ◽

Shuangshuang Ni ◽

Senmin Wu ◽

Hui Zhu ◽

Kai Chen ◽

...

Keyword(s):

Blood Flow ◽

High Frequency ◽

Spermatic Cord ◽

Testicular Torsion ◽

Color Doppler ◽

Case Series ◽

Important Indicator ◽

Flow Signal ◽

Diagnostic Characteristics ◽

Whirlpool Sign

Abstract Background To investigate the diagnostic characteristics of high-frequency ultrasound with color doppler flow signal in pediatric testicular torsion to increase the diagnostic accuracy.Methods Seven pediatric patients from October 2017 to August 2019 with preserved blood flow signal but surgically diagnosed as testicular torsion were retrospectively included into the study. The imaging manifestations of high-frequency ultrasonography were evaluated.Results Seven cases of testicular torsion with preserved blood flow aging from 49 days to 15 years old were included in the study. All the cases had preserved blood flow in testis, but the surgical findings showed various twist degrees from 90° to 540°. Preoperative ultrasound showed spermatic cord distortion in all cases, and the testicular long axis tilted in four cases.Conclusion In some testicular torsion cases, color doppler may show normal or increased blood flow signals in the testis. The “whirlpool sign” in the spermatic cord is an important indicator suggestive of testicular torsion.

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