0521779407-20 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:22
1434 Torsion of Appendix Testis Torsion of Testis and Spermatic Cordfollow-up
n/a
complications and prognosis
n/aTORSION OF TESTIS AND SPERMATIC CORD
ARTHUR I. SAGALOWSKY, MD
history & physical
■most common in adolescents
■due to a medial rotation of spermatic cord acutely occluding testis
blood supply
■sudden, severe pain over testis
■scrotal pain may produce nausea, abdominal pain
■early, may detect testis high in scrotum, transverse lie, epididymis
draped anteriorly
■later, diffuse swelling masks signs
■scrotal skin may be inflamed
tests
■urinalysis usually normal
■ultrasound and/or nuclear scan highly sensitive – shows hyperemic
ring surrounding “cold testis,” i.e., no uptake of tracer
differential diagnosis
■Torsion of appendix testis – vestigial mullerian remnant at upper
pole of testis; most often in children; no treatment necessary
management
n/a
specific therapy
■emergency surgical repair within 3–4 hours of onset to prevent testis
atrophy
➣detorsion of affected side
➣orchiopexy on both sides
follow-up
■for resolution of acute event
■potential long term impact on fertility, testosterone secretion
complications and prognosis
n/a