Twist and Shout: A Clinical and Experimental Review of Testicular Torsion

Riyad T. Ellati, Parviz K. Kavoussi, Terry T. Turner, Jeffrey J. Lysiak From the Department of Urology, University of Virginia Health System, USA Purpose: This review addresses different aspects of testicular torsion from the clinical perspective as well as the basic cellular and molecular events responsible for the post-torsion testicular changes and pathology, including tissue ischemia-reperfusion injury. Materials and Methods: A review of all published literature on testicular torsion was performed by use of two search engines. Results: Testicular torsion, or more correctly termed torsion of the spermatic cord, is a surgical emergency in order to salvage the testis. Its incidence is approximately 1 in 4,000 per annum. Testicular torsion must be treated promptly to avoid loss of the ipsilateral testis; however, even with torsion repair and gross testicular salvage, significant injury may still occur. Conclusions: The cellular and molecular mechanisms leading to ischemiareperfusion injury are incompletely understood, and adjuncts to surgical treatment have received little attention. Understanding the cellular and molecular effects is important because 25% of males with a history of torsion may experience adult infertility. This review emphasizes current knowledge of basic science results and clinical outcomes of testicular torsion. (Korean J Urol 2009;50:1159-1167) 󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏