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Testis torsion in undescended testis
Journal of pediatric urology(2013) 9, 793-797Journal of emergency medicine, (2012) 42, 5, 538-539Journal of urology 2006 Jun;175(6):2287-9
8-15wks fetusCSL regressionGubernaculum pull downInsulin like factor by leydig cellAMH(MIS)
25-35wks fetusAndrogen, genito-femoral n.>>calcitonin gene related peptideLimb bud “progress zone”
• Undescended testis in full term:3.5%– Prevalence in 1 y/o: 1%– 75% in the inguinal canal
• Torsion in cryptorchidism
–23% testis torsion
– Risk: 10X– Salvage rate: 10% (56% in pure torsion)
Diagnosis
• S/S– Child unexplained groin/abd pain– Tender groin with swelling +/- mass – Ipsilateral hemiscrotum
• Workup– Echo– explorative
Lt scrotum: empty Heterogenous testis texture
No flow in testis But surrounding hyperemic
D/D: incarcerated hernia
MECHANISM?
• ?• NTD with UD, abnormal contraction/spasm of
Cremasteric m.– Black entrance to scrotum
• Especially in the Cerebral palsy and neuromuscular disease child
Key concepts
• Testis torsion in UDT is not uncommon–Delayed Dx make low salvage rate
• Abdominal pain in children–Empty scrotum?– Inguinal mass? –D/D incarcerated hernia? Colic pain?
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