Risk Factors for Testicular Torsion
The primary risk factor for testicular torsion is the presence of a bell-clapper deformity, which is an anatomical defect that allows the testicle to rotate freely within the tunica vaginalis. 1, 2
Age Distribution
- Testicular torsion has a bimodal age distribution with peaks in:
- While most common in adolescents, cases can occur in adults as well 1
Anatomical Factors
- Bell-clapper deformity is the most significant anatomical risk factor, characterized by inadequate fixation of the testis to the scrotal wall 1, 2
- High-riding testicle (abnormal position within the scrotum) may increase risk 3
Clinical History Factors
- Previous episodes of similar pain that resolved spontaneously (intermittent torsion) are reported in up to 50% of patients 2
- Absence of inflammation or infection (distinguishing it from epididymitis) 3
Environmental and Physical Factors
- Cold weather or ambient temperature changes may trigger contraction of the cremasteric muscle, potentially initiating torsion 1
- Physical activity or trauma to the area can precipitate torsion in those with predisposing anatomy 1
Diagnostic Considerations
- Negative Prehn sign (pain not relieved when testicle is elevated) is characteristic of torsion 3, 4
- Sudden onset of severe pain distinguishes torsion from other causes of scrotal pain like epididymitis, which typically has a more gradual onset 3, 4
- Nausea and vomiting commonly accompany the severe pain 1
Prognostic Factors
- Duration of symptoms is the single most important predictor of testicular salvage 5
- Critical time window of 6-8 hours exists before permanent ischemic damage occurs 3, 4
- Degree of torsion (rotation of the spermatic cord) affects severity but is less predictive of salvage than symptom duration 5
Clinical Pearls and Pitfalls
- The absence of cremasteric reflex is not a reliable indicator of testicular torsion 1
- Normal ultrasound findings cannot completely exclude the diagnosis of testicular torsion 1
- The TWIST score can assist in clinical decision-making but should not be used in isolation 1
- Testicular torsion requires immediate urological consultation as outcomes are time-sensitive 3, 1