Testicular Torsion

What is Testicular Torsion?

Torsion of the testis is a pathological twisting of the spermatic cord, which is caused by turning the fold between the testicle and its appendage (mesorchium). And this, in turn, is the cause of infringement or necrosis of testicular tissue.

The frequency of detection of testicular torsion in urological clinics is 1 in 500 patients. 20% of cases of the disease are detected in the first 10 years of a boy’s life. At the age of 10 years before puberty is diagnosed in 50% of patients. As can be seen, mechanical factors, for example, testicular torsion, play the main role in the etiopathoginesis of acute diseases of the testes of children.

Testicular Torsion Classification
There are two forms of the disease:

  1. Non-vaginal testicular torsion – above the parietal attachment of the leaf of the vaginal process of the peritoneum. It is diagnosed before the age of 1 year.
  2. Intravaginal testicular torsion. The disease often affects children than adults.

Causes Torsion

Important factors that trigger testicular torsion can be bruises and scrotal injuries, abdominal tension, sudden movements, followed by a reflex contraction of the muscle that lifts the testicle. If there is no normal attachment of the testicle to the bottom of the scrotum (an anomaly that occurs during the period when the appendage joins the testicle), mutual fixation is violated. This, in turn, leads to the separation of these entities. It is subject to twisting of testicles in case of malformations caused by cryptorchidism (impaired migration to the scrotum).

Pathogenesis during Testicular Torsion

The rotation of the testicle around the vertical axis is noted. If the rotation of the testicle and spermatic cord is greater than 180 °, there is a circulatory disturbance, and multiple hemorrhages are observed in the testicle, vein thrombosis of the spermatic cord is diagnosed, serous-hemorrhagic transudate appears in the cavity of the testicle membrane. The scrotal skin also becomes swollen.

Non-vaginal (suprashell) torsion of the testicle occurs along with its membranes. Regarding the vaginal process of the peritoneum, the testicles are located mesoperitoneally, and its fixation is not broken. The main importance for the development of this pathology is not a malformation of it, but the morphological immaturity of the spermatic cord and the tissues surrounding it. This is the hypertonicity of the muscle that raises the testicle, loose fusion of the membranes, a wide short inguinal canal, which is almost directly directed.

Intravaginal (intrathecal) testicular torsion – an intravaginal form – is noted in the vaginal cavity. The disease is diagnosed in children after 3 years, especially at the age of 10 to 16 years. Torsion of the testicle in this case occurs in this way. During the contraction of the muscle that raises the testicle, it, like the surrounding shells, is pulled upward, making a rotational movement. The sweat and rigidity of the fusion of the membranes, together with the inguinal canal, which intimately covers the spermatic cord in the form of a tube (in older children), does not allow the testicle to completely wrap around its axis. This leads to the fact that at a certain moment the rotation stops.

A testicle with a long mesentery and, as a result, having a high degree of mobility inside the cavity of the vaginal process of the peritoneum, continues to rotate by inertia. Muscle fibers relax later. The testicle, raised in the upper part of the scrotum cavity, is fixed in a horizontal position, since the convex parts hold it.

In the future, with the contraction of the muscle that raises the testicle, the inversion continues. The longer the mesentery is, the contraction force of the muscle raising the testicles is greater, and the mass of the testicle is higher, the more pronounced is the inversion. The increase in the number of cases of intranaginal twisting in the prepubertal and puberty periods is explained by a disproportionate increase in the mass of the testicle at this age. This is evidence that in the mechanism of intravaginal testicular torsion, an imbalance in the growth of the reproductive apparatus is important, which does not exclude the influence of other factors.