Testis Torsiyonu
Özet
Testis torsiyonu, spermatik kordun kendi üzerinde dönmesi sonucu venöz tıkanıklık ve arteriyel akımın yetersizliği ile testiste kanlanmanın bozulması ve iskemiye gitmesidir. Spermatogenik hücrelerdeki hasar 6 saate kadar geri dönüşümlü iken bu süre aşıldığında geri dönüşümsüz hasar riski de artmaktadır. Her yaşta görülmesine rağmen 12-18 yaş ve yenidoğan grubunda olmak üzere iki tepe noktalı bir dağılım sergilemektedir. En sık görülen bulgu, tek taraflı skrotal ağrı olup bu duruma bulantı ve kusma eşlik edebilir. İskemi ve şüpheli torsiyon için testis değerlendirmesi (Testicular Workup for Ischemia and Suspected Torsion, TWIST) skoru klinik bir karar vermede kullanılabilmekle birlikte asla tek başına kullanılmamalıdır. Testis torsiyon şüphesi, süre duyarlı olduğundan multidisipliner yönetim ile üroloji bölümü sürece dahi edilmelidir. Erken tanı ve tedavinin önem taşıdığı klinik bir durumdur.
Testicular torsion is the twisting of the spermatic cord upon itself, resulting in impaired blood flow to the testicle due to venous obstruction and insufficient arterial flow, leading to ischemia. Damage to spermatogenic cells is reversible within 6 hours, but beyond this time, the risk of irreversible damage increases. Although it can occur at any age, it exhibits a two-peak distribution, particularly in 12-18 age and gruop newborns. The most common finding is unilateral scrotal pain, which may be accompanied by nausea and vomiting. The Testicular Workup for Ischemia and Suspected Torsion (TWIST) score can be used to make a clinical decision regarding ischemia and suspected torsion, but it should never be used alone. Suspected testicular torsion requires multidisciplinary management, including the urology department, due to its time-sensitive nature. Early diagnosis and treatment are crucial in this clinical situation.
Referanslar
Kroger-Jarvis MA, Gillespie GL. Presentation of Testicular Torsion in the Emergency Department. Adv Emerg Nurs J.2016;38(4):295-299.doi: 10.1097/TME.0000000000000119.
Tsili AC, Sofikitis N, Stiliara E, Argyropoulou MI. MRI of testicular malignancies. Abdom Radiol (NY). 2019 Mar;44(3):1070-1082.
Yang Y, Workman S, Wilson MJ. The molecular pathways underlying early gonadal development. J Mol Endocrinol. 2019 Jan;62(1):R47-R64.
Tunalı S, Başar R. Testisin Vasküler Anatomisi. Turkiye Klinikleri J Urology-Special Topics. 2012;5(3):1-5.
Huang WY, Chen YF, Chang HC, et al. The incidence rate and characteristics in patients with testicular torsion: a nationwide, population-based study: apa, 2013,102:8, 363-7.
Sharp VJ, Kieran K, Arlen AM. Testicular torsion: diagnosis, evaluation, and management. Am Fam Phys, 88 (12) (2013), pp. 835-840
Laher A, Ragavan S, Mehta P, et al. Testicular torsion in the emergency room: a review of detection and management strategies. Open Access Emerg Med, 12 (2020), pp. 237-246.
Ta A, D’Arcy F, Hoag N, et al. Testicular torsion and the acute scrotum: current emergency management. Eur J of Emerg Med, 23 (3) (2016), pp. 160-165.
Rosenberg H, Long B, Keays M. Just the facts: assessment and management of testicular torsion in the emergency department. CJEM,23 (6) (2021), pp. 740-743.
Nassiri N, Zhu T, Asanad K, et al. Testicular torsion from Bell-clapper deformity.Urol, 147 (2021), p. 275.
Lacy A, Smith A, Koyfman A, et al. High risk and low prevalence diseases: Testicular torsion. The American Journal of Emergency Medicine. 2023;66:98-104.
Osumah TS, Jimbo M, Granberg CF, et al. Frontiers in pediatric testicular torsion: an integrated review of prevailing trends and management outcomes. J Pediatr Urol, 14 (5) (2018), pp. 394-401.
Zhong H, Bi Y. Pediatric trauma-induced testicular torsion: a surgical emergency. Urol Int, 105 (3–4) (2021), pp. 221-224.
Schick MA, Sternard BT. Testicular Torsion. 2023 Jun 12. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan–.
Türk H, Çelik O, İşoğlu CS, et al. Erişkinde Testis Torsiyonu. Olgu Sunumu. Tepecik Eğit Hast Derg 2014; 24 (1): 73-76.
Qin K, Qu L. Diagnosing with a TWIST: systemic review and meta-analysis of a testicular torsion risk score J Urol, 208 (1) (2022), pp.62-70.
Boettcher M, Bergholz R, Kerbs TF, et al. Clinical predictors of testicular torsion in children.Urol, 79 (2012), pp. 670-674.
Sheth KR, Keays M, Grimsby GM, et al. Diagnosing testicular torsion before urological consultation and imaging: validation of the TWIST score. J Urol, 195 (6) (2016), pp. 187-1876.
Frohlich L, Paydar-Darian N, Cilento Jr. C, et al. Prospective validation of clinical score for males presenting with an acute scrotum. Acad Emerg Med, 24 (12) (2017), pp. 1474-1482.
Qin K, Qu L. Diagnosing with a TWIST: systemic review and meta-analysis of a testicular torsion risk score. J Urol, 208 (1) (2022), pp. 62-70.
Barbosa JA, Tiseo BC, Barayan GA, et al. Development and initial validation of a scoring system to diagnose testicular torsion in children. J Urol, 189 (5) (2013)(1859–1854).
Prando D. Torsion of the spermatic cord: the main gray-scale and doppler sonographic signs. Abdom Imaging (2009)[Sep-Oct. 34 (5):648-61].
Expert Panel on Urological Imaging, Wang CL, Aryal B, Oto A, et al. ACR appropriateness criteria® acute onset of scrotal pain-without trauma, without antecedent mass. J Am Coll Radiol, 16 (5S) (2019), pp. S38-S43.
Pogorelić Z, Mustapić K, Jukić M, et al. Management of acute scrotum in children: a 25-year single center experience on 558 pediatric patients. Can J Urol, 23 (6) (2016), pp. 8594-8601.
Mellick LB, Sinex JE, Gibson RW, et al. A Systematic Review of Testicle Survival Time After a Torsion Event. Pediatr Emerg Care. 2019 Dec;35(12):821-825.
Friedman AA, Palmer LS, Maizels M, et al. Pediatric acute scrotal pain: A guide to patient assessment and triage. J Pediatr Urol. 2016 Apr;12(2):72-5.
Fantasia J, Aidlen J, Lathrop W, et al. Undescended Testes: A Clinical and Surgical Review. Urol Nurs. 2015 May-Jun;35(3):117-26.
Referanslar
Kroger-Jarvis MA, Gillespie GL. Presentation of Testicular Torsion in the Emergency Department. Adv Emerg Nurs J.2016;38(4):295-299.doi: 10.1097/TME.0000000000000119.
Tsili AC, Sofikitis N, Stiliara E, Argyropoulou MI. MRI of testicular malignancies. Abdom Radiol (NY). 2019 Mar;44(3):1070-1082.
Yang Y, Workman S, Wilson MJ. The molecular pathways underlying early gonadal development. J Mol Endocrinol. 2019 Jan;62(1):R47-R64.
Tunalı S, Başar R. Testisin Vasküler Anatomisi. Turkiye Klinikleri J Urology-Special Topics. 2012;5(3):1-5.
Huang WY, Chen YF, Chang HC, et al. The incidence rate and characteristics in patients with testicular torsion: a nationwide, population-based study: apa, 2013,102:8, 363-7.
Sharp VJ, Kieran K, Arlen AM. Testicular torsion: diagnosis, evaluation, and management. Am Fam Phys, 88 (12) (2013), pp. 835-840
Laher A, Ragavan S, Mehta P, et al. Testicular torsion in the emergency room: a review of detection and management strategies. Open Access Emerg Med, 12 (2020), pp. 237-246.
Ta A, D’Arcy F, Hoag N, et al. Testicular torsion and the acute scrotum: current emergency management. Eur J of Emerg Med, 23 (3) (2016), pp. 160-165.
Rosenberg H, Long B, Keays M. Just the facts: assessment and management of testicular torsion in the emergency department. CJEM,23 (6) (2021), pp. 740-743.
Nassiri N, Zhu T, Asanad K, et al. Testicular torsion from Bell-clapper deformity.Urol, 147 (2021), p. 275.
Lacy A, Smith A, Koyfman A, et al. High risk and low prevalence diseases: Testicular torsion. The American Journal of Emergency Medicine. 2023;66:98-104.
Osumah TS, Jimbo M, Granberg CF, et al. Frontiers in pediatric testicular torsion: an integrated review of prevailing trends and management outcomes. J Pediatr Urol, 14 (5) (2018), pp. 394-401.
Zhong H, Bi Y. Pediatric trauma-induced testicular torsion: a surgical emergency. Urol Int, 105 (3–4) (2021), pp. 221-224.
Schick MA, Sternard BT. Testicular Torsion. 2023 Jun 12. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan–.
Türk H, Çelik O, İşoğlu CS, et al. Erişkinde Testis Torsiyonu. Olgu Sunumu. Tepecik Eğit Hast Derg 2014; 24 (1): 73-76.
Qin K, Qu L. Diagnosing with a TWIST: systemic review and meta-analysis of a testicular torsion risk score J Urol, 208 (1) (2022), pp.62-70.
Boettcher M, Bergholz R, Kerbs TF, et al. Clinical predictors of testicular torsion in children.Urol, 79 (2012), pp. 670-674.
Sheth KR, Keays M, Grimsby GM, et al. Diagnosing testicular torsion before urological consultation and imaging: validation of the TWIST score. J Urol, 195 (6) (2016), pp. 187-1876.
Frohlich L, Paydar-Darian N, Cilento Jr. C, et al. Prospective validation of clinical score for males presenting with an acute scrotum. Acad Emerg Med, 24 (12) (2017), pp. 1474-1482.
Qin K, Qu L. Diagnosing with a TWIST: systemic review and meta-analysis of a testicular torsion risk score. J Urol, 208 (1) (2022), pp. 62-70.
Barbosa JA, Tiseo BC, Barayan GA, et al. Development and initial validation of a scoring system to diagnose testicular torsion in children. J Urol, 189 (5) (2013)(1859–1854).
Prando D. Torsion of the spermatic cord: the main gray-scale and doppler sonographic signs. Abdom Imaging (2009)[Sep-Oct. 34 (5):648-61].
Expert Panel on Urological Imaging, Wang CL, Aryal B, Oto A, et al. ACR appropriateness criteria® acute onset of scrotal pain-without trauma, without antecedent mass. J Am Coll Radiol, 16 (5S) (2019), pp. S38-S43.
Pogorelić Z, Mustapić K, Jukić M, et al. Management of acute scrotum in children: a 25-year single center experience on 558 pediatric patients. Can J Urol, 23 (6) (2016), pp. 8594-8601.
Mellick LB, Sinex JE, Gibson RW, et al. A Systematic Review of Testicle Survival Time After a Torsion Event. Pediatr Emerg Care. 2019 Dec;35(12):821-825.
Friedman AA, Palmer LS, Maizels M, et al. Pediatric acute scrotal pain: A guide to patient assessment and triage. J Pediatr Urol. 2016 Apr;12(2):72-5.
Fantasia J, Aidlen J, Lathrop W, et al. Undescended Testes: A Clinical and Surgical Review. Urol Nurs. 2015 May-Jun;35(3):117-26.
