Torsion of testes is may be due to: March 2013 (e, f)
Correct Answer: All of the above
Description: Ans. D i.e. All of the above Testicular torsion It is the torsion of the spermatic cord structures and subsequent loss of the blood supply to the ipsilateral testicle. This is a urological emergency; early diagnosis and treatment are vital to saving the testicle and preserving future feility. Testicular torsion is primarily a disease of adolescents and neonates. It is the most common cause of testicular loss in these age groups. Surgical treatment may prevent fuher ischemic damage to the testis. Testicular torsion is caused by twisting of the spermatic cord and the blood supply to the testicle. With mature attachments, the tunica vaginalis is attached securely to the posterior lateral aspect of the testicle, and, within it, the spermatic cord is not very mobile. If the attachment of the tunica vaginalis to the testicle is inappropriately high, the spermatic cord can rotate within it, which can lead to intravaginal torsion. This defect is referred to as the bell clapper deformity. This occurs in about 17 % of males and is bilateral in 40%. Intravaginal torsion most commonly occurs in adolescents. It is thought that the increased weight of the testicle after pubey, as well as sudden contraction of the cremasteric muscles (which inses in a spiral fashion into the spermatic cord), is the impetus for acute torsion. By contrast, neonates more often have extravaginal torsion. This occurs because the tunica vaginalis is not yet secured to the gubernaculum and, therefore, the spermatic cord, as well as the tunica vaginalis, undergo torsion as a unit. Extravaginal torsion is not associated with bell clapper deformity. This can occur up to months prior to bih. Of course, neonates can have intravaginal torsion and this should be managed in the same manner as adolescents. Testicular torsion is associated with testicular malignancy, especially in adults According to Prehn's sign, the physical lifting of the testicles relieves the pain of epididymitis but not pain caused by testicular torsion
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