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CMAJ : Canadian Medical Association... Jul 2019
Topics: Adolescent; Child; Child, Preschool; Humans; Infant; Male; Spermatic Cord Torsion; Urologic Surgical Procedures, Male
PubMed: 31308008
DOI: 10.1503/cmaj.190158 -
Canadian Family Physician Medecin de... Sep 2021As a family physician caring for a large pediatric population, I evaluate numerous adolescents with testicular pain. Given the gravity of prognosis for late treatment of...
QUESTION
As a family physician caring for a large pediatric population, I evaluate numerous adolescents with testicular pain. Given the gravity of prognosis for late treatment of children with testicular torsion, what are best practices for its assessment and management?
ANSWER
The Testicular Workup for Ischemia and Suspected Torsion (TWIST) score has been developed and validated to identify children at risk of testicular torsion. If the TWIST score is 0 and clinical suspicion is low in the office setting, a referral to urology for urgent consultation is not needed. If the TWIST score is 1 or higher or if the clinical presentation suggests torsion, manual detorsion should be attempted and the patient should be urgently sent to the nearest emergency department.
Topics: Adolescent; Child; Emergency Service, Hospital; Humans; Male; Pain; Referral and Consultation; Spermatic Cord Torsion; Testis
PubMed: 34521708
DOI: 10.46747/cfp.6709669 -
African Journal of Paediatric Surgery :... 2022Rotation of the testis around the axis of the spermatic cord results in tissue ischaemia and testicular torsion (TT). TT in the newborn infant in the 1st month of life... (Review)
Review
Rotation of the testis around the axis of the spermatic cord results in tissue ischaemia and testicular torsion (TT). TT in the newborn infant in the 1st month of life is referred to as neonatal TT (NTT) or perinatal TT and occurs in 6.1/100, 000 live births. The true incidence could be higher as some of these occur prenatally and can be asymptomatic. TT can be extravaginal, intravaginal and mesorchial and NTT is usually extravaginal. Physical examination can be adequate for the diagnosis, and utility of ultrasound (US) is mainly to exclude other conditions. If the timing of the torsion is prenatal, the testicle may not be salvageable. But, in certain situations, these could be asymptomatic bilateral TT. When the timing of torsion is not simultaneous (asynchronous torsion) early contralateral orchiopexy done at the time of exploration would prevent the occurence of asynchronous torsion. Non.operative maneuvres to detorse in NTT are not successful and not recommended. This review focuses on the diagnostic approach and management.
Topics: Humans; Infant, Newborn; Male; Spermatic Cord Torsion; Testis
PubMed: 34916342
DOI: 10.4103/ajps.AJPS_153_20 -
Current Urology Reports May 2018Chronic scrotal pain (CSP) is a common yet poorly understood condition, with significant impacts on overall quality of life. Many patients will have sought evaluation... (Review)
Review
PURPOSE OF REVIEW
Chronic scrotal pain (CSP) is a common yet poorly understood condition, with significant impacts on overall quality of life. Many patients will have sought evaluation and management from multiple providers in an attempt to find a solution for their pain.
RECENT FINDINGS
Despite many emerging treatments for CSP and further understanding of the potential etiologies and pathophysiological basis of the condition, its natural history is poorly understood. It is also important to recognize the psychosocial impact of CSP and consider formal referral for psychological evaluation and treatment if the patient endorses significant psychiatric responses to pain. It is important to also recognize the neuropathic component of pain that may arise in patients with CSP. Neuropathic medications show promise as a narcotic-sparing pharmacological intervention. There are promising surgical options for CSP including microsurgical denervation of the spermatic cord. This article highlights the current best practice recommendations on the evaluation and management of chronic scrotal pain.
Topics: Chronic Pain; Denervation; Genital Diseases, Male; Humans; Male; Quality of Life; Scrotum; Spermatic Cord
PubMed: 29855742
DOI: 10.1007/s11934-018-0811-2 -
Archives de Pediatrie : Organe Officiel... Jan 2021Testicular torsion (TT) occurs when the testis rotates around the axis of the spermatic cord attachments and prevents blood flow to the testis, resulting in tissue... (Review)
Review
Testicular torsion (TT) occurs when the testis rotates around the axis of the spermatic cord attachments and prevents blood flow to the testis, resulting in tissue ischemia. If this occurs in the first month of life it is referred to as "perinatal TT" (PTT) or "neonatal TT" (NTT). PTT has an incidence of 6.1 per 100,000 live births. Some of these cases occur prenatally. It can be missed on the initial newborn examination, as it can be asymptomatic. Hence, the true incidence is much higher since it is underdiagnosed. The types of TT include extravaginal, intravaginal, and mesorchial. Most cases of PTT are extravaginal. The diagnosis can generally be made on physical examination. Ultrasonography (US) can help exclude other rare diagnoses as long as surgical intervention is not delayed. There has been some debate regarding the timing of surgery. Although the torsed testicle may not be salvageable, the likelihood of asymptomatic bilateral TT has to be borne in mind and contralateral orchiopexy done at the time of exploration would prevent an asynchronous torsion. Nonoperative maneuvers to detorse in PTT are not recommended. The evaluation, diagnostic approach, and management of this relatively rare condition are described.
Topics: Asymptomatic Diseases; Humans; Infant, Newborn; Male; Missed Diagnosis; Neonatal Screening; Orchiopexy; Physical Examination; Spermatic Cord Torsion; Ultrasonography
PubMed: 33277134
DOI: 10.1016/j.arcped.2020.10.006 -
Veterinary Research Communications Jun 2022The purpose of this review is to provide a comprehensive comparison of spermatic cord torsion in domestic animals. Spermatic cord torsion leads to occlusion of... (Review)
Review
The purpose of this review is to provide a comprehensive comparison of spermatic cord torsion in domestic animals. Spermatic cord torsion leads to occlusion of testicular blood flow resulting in ischemia and tissue hypoxia. Spermatic cord torsion has been reported in all domestic mammals but dogs and horses are overrepresented. Abdominal pain (colic), anorexia, vomiting, lameness, and stiff gait are the most common clinical signs reported. The condition may be asymptomatic in cases of a low degree of spermatic cord torsion. In dogs, spermatic cord torsion is most commonly reported in undescended testes, which in some cases are neoplastic. However, in horses, spermatic cord torsion occurs more commonly in scrotal testes. Surgical treatment for spermatic cord torsion depends upon the degree and duration of torsion. If the affected testis is located within the scrotum and determined to still be viable, detorsion with orchidopexy can be performed. Orchiopexy of the unaffected scrotal testis is also recommended in stallions. If the affected testis cannot be salvaged, unilateral or bilateral orchidectomy is recommended. In all cases of spermatic cord torsion of an undescended testis, orchidectomy is recommended. Veterinarians should be aware of the clinical signs and treatment options for spermatic cord torsion in domestic mammals.
Topics: Animals; Dog Diseases; Dogs; Horse Diseases; Horses; Male; Mammals; Spermatic Cord Torsion; Testis
PubMed: 35001221
DOI: 10.1007/s11259-021-09873-5 -
The Urologic Clinics of North America Feb 2021The robotic platform offers theoretical and practical advantages to microsurgical male infertility surgery. These include reduction or elimination of tremor,... (Review)
Review
The robotic platform offers theoretical and practical advantages to microsurgical male infertility surgery. These include reduction or elimination of tremor, 3-dimensional visualization, and decreased need for skilled surgical assistance. This article reviews the application of robotic surgery to each of the 4 primary male infertility procedures: vasectomy reversal, varicocelectomy, testicular sperm extraction, and spermatic cord denervation. Historical perspective is presented alongside the available outcomes data, which are limited in most cases. Before the robotic approach can be widely adopted, further clinical trials are needed to compare outcomes and costs with those of other validated surgical techniques.
Topics: Azoospermia; Denervation; Forecasting; Humans; Infertility, Male; Male; Microsurgery; Robotic Surgical Procedures; Spermatic Cord; Testis; Varicocele; Vasovasostomy
PubMed: 33218587
DOI: 10.1016/j.ucl.2020.09.009 -
Mayo Clinic Proceedings Apr 2019
Topics: Aged; Genital Neoplasms, Male; Humans; Liposarcoma; Male; Spermatic Cord
PubMed: 30947844
DOI: 10.1016/j.mayocp.2019.02.005 -
Translational Andrology and Urology Apr 2017Chronic testicular pain although becoming very common in our patient population poses a challenge to the physician, the patient and his family. The pathogenesis of... (Review)
Review
Chronic testicular pain although becoming very common in our patient population poses a challenge to the physician, the patient and his family. The pathogenesis of chronic orchialgia (CO) is not well understood. The objective of this paper is to review the current literature on chronic testicular pain and its management and to propose an algorithm for its treatment. Abstracts, original papers and review articles were reviewed during a literature search using words such as testicular pain, CO, and microsurgical anatomy of spermatic cord. Chronic scrotal content pain (CSP) is a difficult condition to treat and could be idiopathic or secondary. Conservative therapy is the first line of treatment attempted to allow the patient to return to his routine activities. When conservative treatment fails, patients can now turn toward surgical options such as microsurgical denervation of the spermatic cord (MDSC) which has a success rate published in the 60-85% range and/or minimally invasive therapies such as microcryoablation of the spermatic cord, Botox or Amniofix injection. There is an increase in referrals for CO. The true pathogenesis is still unclear and the road to complete recovery is unsure for certain patients. This paper proposes an algorithm for the management of patients suffering with CO.
PubMed: 28540232
DOI: 10.21037/tau.2017.03.03 -
Current Opinion in Urology Jan 2017Spermatic cord tumors (SCT) are very rare. The present review discusses the most recent literature regarding clinical presentation, pathological characteristics,... (Review)
Review
PURPOSE OF REVIEW
Spermatic cord tumors (SCT) are very rare. The present review discusses the most recent literature regarding clinical presentation, pathological characteristics, diagnosis, and management of SCT.
RECENT FINDINGS
Although the majority of SCT are benign, when malignant almost all SCT are sarcomas. Liposarcomas are the most common; whereas rhabdomyosarcomas recorded the highest tendency of develop distant metastases. The clinical presentation is usually a unilateral solid slow-growing mass at the level of the inguinal canal and of the scrotum. Surgical excision represents the most common used treatment, and considering the risk in developing local recurrence, radical inguinal orchiectomy and resection of the tumor with negative microscopic surgical margins is mandatory. Adjuvant therapies such as radiotherapy and chemotherapy have been suggested in selected patients, but clear data to demonstrate any improvement in survival are not available.
SUMMARY
SCT are rare tumors with high risk of misdiagnosis or mistreatment. The majority are benign, but when malignant almost all are sarcomas. A surgical excision is the treatment of choice; however, no clear data exists documenting the efficacy of a multimodal treatment in reducing high local recurrence rates after surgery.
Topics: Genital Neoplasms, Male; Humans; Liposarcoma; Male; Neoplasm Recurrence, Local; Orchiectomy; Radiotherapy, Adjuvant; Sarcoma; Spermatic Cord
PubMed: 27262142
DOI: 10.1097/MOU.0000000000000318