Testis torsion in undescended testis

Journal of pediatric urology(2013) 9, 793-797Journal of emergency medicine, (2012) 42, 5, 538-539Journal of urology 2006 Jun;175(6):2287-9

8-15wks fetusCSL regressionGubernaculum pull downInsulin like factor by leydig cellAMH(MIS)

25-35wks fetusAndrogen, genito-femoral n.>>calcitonin gene related peptideLimb bud “progress zone”

• Undescended testis in full term:3.5%– Prevalence in 1 y/o: 1%– 75% in the inguinal canal

• Torsion in cryptorchidism

–23% testis torsion

– Risk: 10X– Salvage rate: 10% (56% in pure torsion)

Diagnosis

• S/S– Child unexplained groin/abd pain– Tender groin with swelling +/- mass – Ipsilateral hemiscrotum

• Workup– Echo– explorative

Lt scrotum: empty Heterogenous testis texture

No flow in testis But surrounding hyperemic

D/D: incarcerated hernia

MECHANISM?

• ?• NTD with UD, abnormal contraction/spasm of

Cremasteric m.– Black entrance to scrotum

• Especially in the Cerebral palsy and neuromuscular disease child

Key concepts

• Testis torsion in UDT is not uncommon–Delayed Dx make low salvage rate

• Abdominal pain in children–Empty scrotum?– Inguinal mass? –D/D incarcerated hernia? Colic pain?