Critical Analysis of the Clinical Presentation of Acute Scrotum: A 9-Year Experience at a Single Institution

Predictors of testicular viability in testicular torsion

“…Jefferson et al reported that in their experience no testicle with a history >12 h could be salvaged [7], and Barada et al warned that patients younger than 18 years old are at increased risk of delayed presentation [8]. Testicular infarction begins after 2 h of ischemia, becomes irreversible after 6 h and complete infarction is established after 24 h. Although our experience is consistent with such a natural history, we also observed testicular necrosis (or atrophy after orchidopexy) in patients undergoing early surgery (history <10 h).…”

Surgical management of testicular torsion

“…However, the accuracy of CDS in diagnosing TT can vary significantly in the literature. 10 A recent retrospective study of 298 patients who underwent CDS followed by surgery regardless of the result, CDS was shown to have a sensitivity and specificity for TT of 96.8% and 97.9%, respectively. 4 Positive and negative predictive values were 92.1% and 99.1%, respectively.…”

“…A slight preponderance in left-sided TT has been noted in some series, although the mechanism for this is unclear. [8][9][10][11] Intravaginal torsion most often occurs due to a congenital malformation of the processus vaginalis as the testis descends into the scrotal sac. This type of torsion accounts for the majority of testicular torsions, and is most often seen in pubertal boys, where rapid growth and increased vasculature may be a precursor.…”

“…Some series report nausea and vomiting in 57-69% of patients with TT, with positive predictive values for nausea and vomiting as high as 96% and 98%, respectively, compared with 8% and 4% in appendix of testes and none in epididymo-orchitis. 9,10 Other series have shown that nausea and vomiting do occur in torsion of the testicular appendix and epididymo-orchitis, but the complaint is much rarer. 1,18 Dysuria is an uncommon complaint in testicular torsion, and its presence likely indicates an alternate diagnosis such as epididymoorchitis.…”

“…One study of 83 boys with surgically confirmed torsion demonstrated no salvageable testes after 12 hours of pain. 10 Other studies have demonstrated a rate of organ loss of 64%-90%. 1,34,35 Manual detorsion can lessen the severity of testicular torsion, if tolerated by the patient.…”