Twist and Shout: A Clinical and Experimental Review of Testicular Torsion

Abstract

Purpose: This review addresses different aspects of testicular torsion from the clinical perspective as well as the basic cellular and molecular events responsible for the post-torsion testicular changes and pathology, including tissue ischemia-reperfusion injury. Materials and Methods: A review of all published literature on testicular torsion was performed by use of two search engines. Results: Testicular torsion, or more correctly termed torsion of the spermatic cord, is a surgical emergency in order to salvage the testis. Its incidence is approximately 1 in 4,000 per annum. Testicular torsion must be treated promptly to avoid loss of the ipsilateral testis; however, even with torsion repair and gross testicular salvage, significant injury may still occur. Conclusions: The cellular and molecular mechanisms leading to ischemiareperfusion injury are incompletely understood, and adjuncts to surgical treatment have received little attention. Understanding the cellular and molecular effects is important because 25% of males with a history of torsion may experience adult infertility. This review emphasizes current knowledge of basic science results and clinical outcomes of testicular torsion.

Unilateral testicular torsion following ejaculation by manual sexual stimulation in an adolescent: A case report

“…The entire funiculus turns together with the testis and the gubernaculum [13]. As mentioned above, anatomical abnormalities and cremasteric contractions during ejaculation may cause torsion by rotating the testes medially [4], like in our case.…”

A 40-year-old man with testicular torsion and large bilateral spermatoceles

“…1 The survival rate of the involved testis is associated with the duration and grade of torsion. 2,3 Although spermatic cord torsion can occur at any age, there are few reports of testicular torsion in older individuals. 4,5 Moreover, because of the rare incidence of torsion among the elderly, lack of clinical suspicion may lead to delayed or missed diagnosis.…”

Testicular ischemia-reperfusion may alter micro-rheological parameters in laboratory rats

“…Acute testicular ischemia is still nowadays an important issue in the clinical practice, which is most frequently due to torsion (mainly intra-, extravaginal or mesorchial types) [6,7,29]. Besides the severe pain, the occurring ischemia has influence on the spermatogenesis and furthermore, the injury of the blood-testis barrier can provoke immune processes leading to contralateral injury [12,16,23,31,33].…”

“…Besides the severe pain, the occurring ischemia has influence on the spermatogenesis and furthermore, the injury of the blood-testis barrier can provoke immune processes leading to contralateral injury [12,16,23,31,33]. Concerning the microcirculatory alterations there are numerous literature data with various length of ischemia-reperfusion [7,15,16,27,30]. In this approach, the hemorheological approach is inseparable, since it is well known, that blood and plasma viscosity, hematocrit, red blood cell deformability as well as red blood cell aggregation are major determinants of the microcirculatory flow [e.g.…”