Is testicular torsion more common in older men?

Testicular Torsion is More Common in Younger Males, Not Older Men

Testicular torsion is not more common in older men; it has a bimodal distribution with peaks in neonates and postpubertal boys, and is rare in men over 35 years of age. 1, 2

Epidemiology and Age Distribution

• Testicular torsion affects approximately 3.8 per 100,000 males younger than 18 years annually 3
• The condition has a bimodal distribution, occurring more frequently in neonates and postpubertal boys than in adults 1, 2
• Torsion is rare in patients over 35 years of age 1
• Epididymitis/epididymoorchitis is overwhelmingly the most common cause of acute scrotal pain in men over 25 years of age 1, 4

Comparative Incidence by Age Group

• In prepubertal boys, torsion of testicular appendage is the most common cause of acute scrotal pain 1, 4
• In adolescents and adults up to age 25, testicular torsion is more common, affecting approximately 1 in 4,000 males 5
• In adults over 25 years, epididymitis/epididymoorchitis is the predominant cause of acute scrotal pain 1, 4

Clinical Implications of Age on Testicular Torsion

• Salvage rates are lower in older patients compared to younger patients (41% vs 70.3% in one study) 6
• Older patients tend to have a greater degree of spermatic cord twisting (mean 585 degrees vs 431 degrees in younger patients) 6
• Delayed presentation is more common in adults, contributing to poorer outcomes 6

Diagnostic Considerations

• All males with acute scrotal pain should be evaluated for testicular torsion, regardless of age, but with awareness of the age-related probability 4, 5
• The absence of an ipsilateral cremasteric reflex is the most accurate clinical sign of testicular torsion 5
• Doppler ultrasound is the first-line imaging modality, with sensitivity of 96-100% and specificity of 84-95% 1, 4

Management Pearls

• Testicular torsion requires treatment within 6-8 hours of symptom onset to prevent permanent ischemic damage 1, 2
• Manual detorsion can be attempted but may result in residual torsion in up to 32% of cases 7
• Surgical exploration remains necessary even after apparently successful manual detorsion 7
• Contrary to traditional teaching, testicular torsion occurs in the lateral direction in approximately 33% of cases 7

Rare Cases in Older Men

• While uncommon, cases of testicular torsion in older men have been reported, including a rare case of bilateral testicular torsion in a 57-year-old man 8
• Such cases emphasize the importance of maintaining clinical suspicion for torsion even in atypical age groups 8