TORSION OF THE TESTICLE A Plea for Diagnosis

Angell, J. C.

doi:10.1016/s0140-6736(63)91146-2

Cited by 41 publications

(6 citation statements)

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“…Tables I V and V list the clinical features in all the cases of torsion except the recurrent group described above. Thirty-seven per cent gave a past history of one or more similar attacks of testicular pain and swelling, and other series report even higher figures of 45-52 per cent (Barker and Raper, 1964;Chapman and Walton, 1972). This clearly illustrates the wisdom of carrying out prompt bilateral orchidopexy in patients with features of intermittent recurrent torsion.…”

Section: Clinical Featuresmentioning

confidence: 63%

“…Both Scudder (1901) and Going and Keith (1906) drew attention to the fundamental anatomical abnormality predisposing to intravaginal torsion, namely a freely mobile testis suspended by a long mesorchium within a capacious tunica vaginalis. The high investment of the tunica producing this 'bell clapper' testis has been repeatedly described, and Barker and Raper (1964) suggested that a normal testis will not undergo torsion unless submitted to severe trauma. Where the operative records in the present series included an adequate anatomical description these anomalies were almost universally present.…”

Section: Aetiological Factorsmentioning

confidence: 94%

“…It is surprising, in view of the fact that the anomaly is nearly always present on both sides (Adams and Slade, 1958; Angell, 1963), that bilateral torsion is not a commoner event. The actual force initiating torsion in a susceptible testis is still not clearly understood, though trauma, unusual body movements and the spiral attachment of the cremasteric muscle fibres (Muschat, 1932) have all been implicated.…”

Section: Aetiological Factorsmentioning

confidence: 99%

“…Intermittent torsion may result in testicular infarction either by progressive ischaemia due to repeated episodes (Angell, 1963) or by a subsequent complete and irrevocable twist of the spermatic cord (Taylor, 1960). Patients with recurrent torsion therefore merit early bilateral orchidopexy as a prophylactic measure, and this was practised in 21 cases.…”

Section: Treatmentmentioning

confidence: 99%

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Torsion of the testis and allied conditions

Williamson

1976

Journal of British Surgery

326

161

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In 15 years at Bristol there have been 293 cases of torsion of the testis, 55 cases of torsion of a testicular appendage and 5 cases of testicular ischaemia due to other causes. The risk of a male developing torsion of the testis or its appendix by the age of 25 is about 1 in 160. Both conditions occurred primarily in adolescents, but among prepubertal boys torsion of an appendage was as common as torsion of a normally descended testis. There was a slight left-sided preponderance in testicular torsion, more marked in torsion of the appendages; the incidence of bilateral torsion was 2-0 and 1-8 per cent respectively. The clinical features and differential diagnosis of the two conditions are compared. Torsion of a testicular appendage is the most commonly misdiagnosed scrotal lesion, the preoperative diagnosis being correct in only 11 per cent of cases compared with 90 per cent for torsion of the testis. Twenty-one cases of recurrent torsion underwent prophylactic bilateral orchidopexy. There were 20 cases of torsion of undescended testes, with a salvage rate of only 20 per cent. The overall testicular survival rate was 55-3 per cent. Viability depends upon the possibility of spontaneous reduction, the preoperative delay after the onset of symptoms, the degree of torsion of the cord and the length of follow-up in doubtful cases. Urgent scrotal exploration is advised in every case of acute testicular pain unless there is overwhelming evidence of epididymoorchitis. Exploration of the opposite side is mandatory in torsion of the testis and advisable in torsion of an appendage.

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Section: Clinical Featuresmentioning

confidence: 63%

Section: Aetiological Factorsmentioning

confidence: 94%

Section: Aetiological Factorsmentioning

confidence: 99%

Section: Treatmentmentioning

confidence: 99%

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Torsion of the testis and allied conditions

Williamson

1976

Journal of British Surgery

326

161

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“…On examination he looked a fit boy, but there was some swelling on the right side of his scrotum, although the testis was palpable and not tender. Both testes had a horizontal lie and a diagnosis of torsion was made based on the observations of Angel1 (5). When the testis was explored, it was found that there was a hi h investment of the tunica with the testis lying horizontal an% free (bellclapper testis).…”

mentioning

confidence: 99%

Recurrent torsion of the testis following previous surgical fixation

May

Thomas

1980

Journal of British Surgery

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The Diagnosis of Testicular Torsion

Haynes¹

1983

JAMA

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CORRESPONDENCE in homozygous sickle cell disease (SS) and 5.5 percent in SC/S-/3-thalassemia disease. The numbers of patients were 26 and 19, respectively. The difference in frequency between the two groups is not statistically significant (P>0.05). Yet the authors state that patients with Hb SC and Hb S-fl-thalassemia only should arrange in advance for inflight oxygen. They add: "We believe that adult patients with Hb SS do not need supplemental oxygen unless they are among the 6 percent of adult patients with Hb SS and intact spleens." Admittedly, there are fewer instances of splenic crises in SS disease (4.3 percent as compared with 8 percent in other forms), but it is not splenic crises only that we need to or can prevent by supplemental oxygen. The 6.5 percent of patients with Hb SS who do suffer vasoocclusive crises could benefit from inflight oxygen. The authors also found that whereas 42.9 percent of SS patients in Reno (elevation 4,400 ft) suffered vasoocclusive crises, only 31 percent of SS patients in Lake Tahoe (elevation 6,320 ft) had similar complications. This difference is significant (P<0.05). Watson-Williams also noted this in his critique of the paper,2 but neither he nor the original authors could provide an explanation for this seeming contradiction. In fact, there is no contradiction. Among other things, the sickling process of deoxylfib S is allosterically modified by pH and 2,3-diphosphoglycerate (2,3-DPG). Lowering the pH hastens sickling by decreasing the oxygen affinity of Hb S via the Bohr effect. In contrast, 2,3-DPG has no independent effect on the polymerization of Hb S. Instead it alters pH, which in turn enhances polymerization.3 It follows, therefore, that if the pH effect of 2,3-DPG is annulled by respiratory alkalosis, which occurs to a greater degree at 6,300 ft than 4,400 ft, it cannot influence polymerization of Hb S. While this phenomenon cannot adequately explain the reduced frequency of crises in patients from Denver when they are exposed to high altitudes,4 a comparison of the two studies done so far on the subject" 4 cannot be made since one recorded the frequency of vasoocclusive events' and the other recorded the number of patients who developed similar symptoms.4 In any event, this is one of the more intriguing findings in Claster and associates' study and deserves future investigation.

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TORSION OF THE TESTICLE A Plea for Diagnosis

Cited by 41 publications

References 1 publication

Torsion of the testis and allied conditions

Torsion of the testis and allied conditions

Recurrent torsion of the testis following previous surgical fixation

The Diagnosis of Testicular Torsion

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