PTU - Polskie Towarzystwo Urologiczne
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Testicular torsion – distant results of surgical exploration
Article published in Urologia Polska 2008/61/Supl. 1.


Krzysztof Kraśnicki, Zbigniew Wolski, Janusz Tyloch, Jarosław Leszniewski
Katedra i Klinika Urologii Ogólnej, Onkologicznej i Dziecięcej CM w Bydgoszczy UMK w Toruniu



Testicular torsion is an acute ischemia caused by twist in the spermatic cord obstructing its blood supply. Testicular torsion must be quickly diagnosed and it’s considered a surgical emergency because the testis presents irreversible damage if the torsion is not resolved within the first 6 hours. Testicular torsion is more frequent (90%) in teenagers in patients between 13and 21 years old with incidence one in 4,000 males. Objectives. Analyze distant results of surgical detorsion according to duration of ischemia.
Materials and methods. Between 2004-2007 in Departmentof Urology, 23 patients aged from 9 to 33 were operated because of acute scrotum. Patients were qualified to surgical exploration according to clinical manifestation of suspected testicular torsion and color Doppler sonography. Observation time post surgical treatment was between 7 months and 3 years. Every patient underwent measurements of ipsilateral and contralateral testis and color Doppler flow study. Complete absence of intratesticular blood flow on color Doppler images and decreasing dimensions was diagnostic for testicular atrophy.


In 23 patients who underwent surgical exploration testicular torsion was diagnosed in 20 (87%) of them, 3 of men had torsion of testicular or epididymis appendix. Detorsion and fixation was made in 14 (60%) patients. In 4 (17.4%) men only fixation was performed. During exploration in 2 of patients (8.7%) was found necrosis of the testis and orchidectomy was done. Twisted appendix was removed in 3 boys. Operation procedure time was estimated between 35 and 60 minutes. Men were operated from 1 to 21 hours since first symptoms of acute scrotum. All patients have undergone surgical exploration under 6.5 hours since they were admitted to urological ward (from 15 minutes to 6.5 hours). Patients were divided into 2 groups: first group included the patients with clinical duration of symptoms above 6 hours to
the time of surgery (n=10, duration of symptoms from 6 to 21 hours), second group set patients with clinical duration of symptoms under 6 hours to the time of surgery (n=8). In patient with longer testicular ischemic time, atrophy was observed in 6 (60%). In patients with short ischemic time (under 6 hours) and with no delay in treatment, decreasing dimensions and testicular atrophy was not observed.


Clinical manifestation of acute scrotum must be diagnosed and treated promptly to avoid loss of function of testis. Surgical exploration of twisted testis is mandatory. Duration of ischemia exceeding 6 hours lead to irreversible ischemic and necrotic testicular changes. When torsion of the spermatic cord is found, testicular fixation must be performed.