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Testicular Torsion, Pediatric

Christopher E. Bayne, MD and Michael H. Hsieh, MD, PhD Reviewed 10/2018
 


BASICS

DESCRIPTION

  • Although the term “testicular torsion” (TT) is most commonly used, it is a pathologic misnomer. “Torsion of the spermatic cord” is the anatomically correct description of the urologi...

DIAGNOSIS

ALERT

TT has a diverse spectrum of presentation, from the “classic presentation” to complete absence of ipsilateral scrotal pain. The “classic” history, exam, and imaging findings are helpful...

TREATMENT

GENERAL MEASURES

  • Acute TT requires emergent detorsion.

  • In most circumstances, time of symptom onset equals ischemia time.

  • Rates of orchiectomy sharply increase 6 to 8 hours after symptom onset.

MEDICATION

ONGOING CARE

PROGNOSIS

  • How TT may affect fertility, regardless of whether a testis was saved or removed, is unclear.

  • Some testicular atrophy, even after short-duration TT, is common.

  • Previous TT is a rar...

ADDITIONAL READING

  • Bayne CE, Villanueva J, Davis TD, et al. Factors associated with delayed presentation and misdiagnosis of testicular torsion: a case-control study. J Pediatr.  2017;186:200–204...

CODES

ICD9

  • 608.20 Torsion of testis

  • 608.2 Torsion of testis

  • 608.21 Extravaginal torsion of spermatic cord

  • 608.22 Intravaginal torsion of spermatic cord

  • 608.23 Torsion of appendix testis

  • 608.24 Torsion of ap...

FAQ

  • Q: Does decreased or increased flow on CDUS rule out TT?

  • A: No. In fact, TT in this setting is reported throughout the literature.

  • Q: Can a testis be salvaged despite symptoms of >6 hours duratio...

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