From the Guidelines
The management of bell clapper deformity primarily involves surgical intervention called orchiopexy to prevent testicular torsion, as recommended by the most recent guidelines and studies, including the 2024 update from the Journal of the American College of Radiology 1. The goal of this surgical procedure is to prevent testicular torsion by securing the testicles to the scrotal wall, thereby reducing the risk of testicular ischemia and loss.
- Key aspects of the surgical intervention include:
- Bilateral scrotal exploration and fixation, even if only one testicle shows the deformity, due to the often bilateral nature of the condition.
- Use of non-absorbable sutures (typically 3-0 or 4-0 nylon or prolene) to create adhesions that prevent rotation of the testicles.
- Performance of the procedure under general anesthesia as an outpatient surgery.
- Post-operative care is crucial for a successful recovery and includes:
- Pain management with acetaminophen or NSAIDs.
- Scrotal support and ice application for the first 24-48 hours.
- Limited physical activity for 2-4 weeks. According to the study by Gerena et al 1, MRI has been reported useful in the diagnosis of bell clapper deformity, with findings including hyperintense T2 signal between the posterior aspect of the epididymis and the scrotal wall, described as a “split sign,” correlating with bell clapper deformity, with 83% sensitivity.
- The use of MRI in the diagnosis of bell clapper deformity can aid in the identification of patients at risk for testicular torsion, allowing for prompt surgical intervention to prevent this potentially devastating complication. Therefore, prophylactic fixation via orchiopexy is recommended for individuals with bell clapper deformity due to the high risk of testicular torsion, which can lead to testicular ischemia and loss if not treated promptly, as supported by the latest evidence from the Journal of the American College of Radiology 1.
From the Research
Management and Treatment of Bell Clapper Deformity
The management and treatment of bell clapper deformity typically involve surgical intervention to prevent further episodes of testicular torsion and potential testicular infarction.
- Surgical fixation of the testis, also known as orchiopexy, is the most common treatment approach 2, 3, 4.
- This procedure involves attaching the testis to the scrotum to prevent it from twisting and cutting off its blood supply.
- In some cases, bilateral testicular fixation may be recommended, even if only one testis is affected, to prevent future episodes of torsion 2, 3, 4.
- The goal of treatment is to prevent further episodes of testicular torsion, reduce the risk of testicular infarction, and alleviate symptoms such as acute scrotal pain and nausea.
Diagnostic Features and Management Outcomes
The diagnostic features of bell clapper deformity include:
- Acute scrotal pain that resolves spontaneously 2, 3.
- Transverse orientation of the testis on physical examination 2, 3.
- Presence of a horizontal lie of the testes on examination, which is significantly associated with the existence of the bell-clapper deformity 3.
- Ultrasonography may be used to confirm the diagnosis, but a normal ultrasound examination cannot exclude the diagnosis 5.
Importance of Early Intervention
Early intervention is crucial in the management of bell clapper deformity to prevent further episodes of testicular torsion and potential testicular infarction.
- Delayed treatment can result in increased risk of orchiectomy and decreased testicular preservation rates 6, 4.
- Prompt diagnosis and early treatment of the underlying anatomic deformity (bell clapper deformity) can prevent ischemic consequences on testicular parenchyma due to either recurrent episode of torsion or as a consequence of intravaginal testicular torsion 2.