Renal & Urology

Testicular Torsion

Rotation of the spermatic cord obstructs venous outflow and then arterial inflow, so the testis infarcts within hours unless it is surgically untwisted.

Definition

Testicular torsion is rotation of the spermatic cord causing acute ischaemia of the testis. It is a clinical diagnosis and a surgical emergency; exploration is the only reliable way to confirm or exclude it.

First principles

A bell-clapper testis can twist its own blood supply

The testis is normally anchored posteriorly by the tunica vaginalis. In the bell-clapper configuration that anchoring is absent, so the testis hangs freely and can rotate on its cord. This is intravaginal torsion, the adolescent type, and the underlying anatomy is usually bilateral.

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