Naser Moradi MDAssistant professor in Urology

NormalBell – clapper deformityAppendages : testis ( Mulerian )

Epididymis ( Wolfian )

1/4000 males < 25 yr.s old

Perinatal # 10% ( 70% prenatal )Peripubertal ( 12 – 20 yr.s old )Ages 4 to 6 yr.s ( hyperactive

cremaster )

Increase of testis volume ( puberty , tumor )

Bell – clapper deformityUDT ( intra abdominal )Activity of cremaster muscle

Torsion of appendix testisTorsion of appendix epididymisEpididymitisEpididymo-orchitisInguinal hernia TraumaInsect biteTestis tumorSkin diseases

Melekos (1988) : 100 children < 15 yr.s

42% Testis torsion 32% appendages torsion ****************************** 16% testis torsion 46% appendix torsion 35% other causes

Torsion of undescended testis in a baby receiving hormonal therapy (1993).

Reigler (1972) : 64% of torsed UDTs in adults had tumors.

1.Extravaginal

2.Intravaginal

1, Pain : acute scrotal (90%)2, pain : inguinal & lower abdomen3, Nausea & vomiting (40%)4, Acute abdomen5, previous similar history (36%)6, Usually occurring at rest (4%

previous trauma & 10% after exercise )

7, Usually no urinary symptom ( < 5% )

1, Oedema & erythema of hemiscrotum2, high riding testis : tender ,

firm ,horizontal3, Epididymis not palpable or dislocated4, Fixed testis (no free movement)5, Cremasteric reflex : absent6, Prehn,s sign : negative7, No fever / leukocytosis

1, Extravaginal2, Nontender firm testis3, No erythema / oedema of scrotum4, Discolored scrotum fixed to testis5, Testis is almost always necrotic6, Neonatal operation (inguinal) : ?

*** History & age*** Physical exam*** Absent cremasteric reflex Color doppler ultrasonography : sensitivity 90% specificity 99% false positive 1% Lab. Exams : CBC & U/A Isotope scan *** Surgical exploration

Blood vessels obstruction 6 hours => death of sertoli & spermatogenic cells

10 hours=> death of Leydig cells

Severe atrophy of testis has been seen with “4 hours “ of ischemia

In general : Testis atrophy is uncommon if torsion is treated up to 8 hours of onset of symptoms

Manual detorsionEmergency surgical exploration Bilateral orchiopexy