Anatomic aspects of epididymis and tunica vaginalis in patients with testicular torsion.

OBJECTIVE To analyze the morphology of epididymis and tunica vaginalis as well as their anatomical anomalies in patients with testicular torsion. MATERIALS AND METHODS We studied 25 patients (50 testes) aged between 12 and 23 years (mean 15.6). Torsion length ranged from 2 hours to 2 days (mean 8 hours). Epididymal anatomy was classified in 6 groups: Type I--epididymis united to the testis by its head and tail; Type II--epididymis totally united to the testis; Type III--disjunction of epididymal tail; Type IV--disjunction of epididymal head; Type V--total disjunction between testis and epididymis, and Type VI--epididymal atresia. The type of torsion was classified in 3 groups: Group A--intravaginal torsion; Group B--extravaginal torsion and Group C--torsion due to long mesorchium. RESULTS Of the 50 analyzed testes, 40 (80%) presented bell clapper deformity (with 21 presenting intravaginal torsion); 8 testes (16%) had long mesorchium (4 with torsion), and only 2 (4%) presented normal anatomy in the tunica vaginalis. The most frequently found anatomical relationship between testis and epididymis was Type I--38 cases (76%); Type II relationship was found in 6 cases (12%) and Type III relationship was found in 6 cases (12%). CONCLUSIONS Intravaginal torsion is the most frequent type, and torsion due to long mesorchium is associated with cryptorchism. The most frequently found anatomical relation between testis and epididymis in the study group was Type I.