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Testicular Torsion in 59-Year-Old Man
0022-5347195/1544148oM)3.00/0 Taa JOURNAL OF Uraom Copyright 8 1996 by AMERICAN UROU~ICAL. ASSOCIATION, hC.
Vol. 154, 1480, October 1996 Printed in U.S&
TESTICULAR TORSION IN A 59-YEAR-OLD MAN THOMAS A. LONDERGAN From the Department
of
Urology, Gundersen Clinic, La Crosse, Wisconsin
KEYWORDS:testis, spermatic cord torsion, ultrasonography
We report on a 59-year-old man who presented with an acutely swollen, tender testicle. Color Doppler ultrasonography demonstrated no blood flow to the involved testicle. Scrotal exploration revealed 720-degree torsion of the spermatic cord and bilateral orchiopexy was performed. Spermatic cord torsion should be considered in all older men who present with acute scrotal pain. Color Doppler ultrasound can be helpful in confirming the diagnosis. CASE REPORT
A 59-year-old man presented with right scrotal and testicular pain 6 hours in duration. The pain had begun abruptly in the morning, and was constant and severe. He denied any voiding symptoms, or a history of pain or scrotal trauma. "he left testicle was nontender. On physical examination the right testicle was enlarged, fkm and extremely tender. "here was no hydmcele and the epididymis could not be palpated as separate from the testicle. There was no relief of pain with elevation (negative Prehn's sign) and no horizontal lie. The left scrotum and testicle were normal on examination. The prostate was small, symmetrical and nontender. Urinalysis was unremarkable. Color Doppler ultrasound of the scrotum using an Accuson 128 X P l O probe and a 7 MHz. linear transducer showed absence of blood flow to the right testicle with normal flow on the left side. Scrotal exploration revealed 720-degree intravaginal torsion of the right spermatic cord and a firm mottled testis (see figure). Torsion was reduced and orchiopexy was performed on the contralateral side. Right orchiopexy was then performed and the wound was closed. One week later the patient was essentially pain-free and both testes were palpably normal. DISCUSSION
Testicular torsion is generally thought to occur only in children and adolescents. Recent reports document that 26 to 39%of cases occur in men older than 21 years and up to 10% in those older than 30 years.1.2 Because of the rarity of this condition in older men and the relative prevalence of epididymitis as a cause of scrotal pain and swelling, most cases are misdiagnosed and ultimately result in orchiectomy or testicular atrophy. Three men who were older than our patient have reportedly had testicular torsion (62,68 and 69 years old, respectively). Testicular salvage was achieved in 1 of 3 of these cases. In all cases, including ours, torsion was intravaginal rather than extravaginal. Color Doppler ultrasonography has been shown to have an accuracy of greater than 90% in diagnosing testicular torsion.3 However, false-negative findings are possible using this test and surgical intervention should not be postponed or denied simply on the basis of negative ultrasound. In our case ultrasound did not delay surgical exploration and was accurate in showing the absence of blood flow to the affected testicle. Accepted for publication April 13,1995.
Exploration reveals 720-degree torsion of right spermatic cord CONCLUSIONS
Our case demonstrates that testicular torsion can OCCUT in an older man. History and physical examination remain the key to the diagnosis. Color Doppler ultrasound can be helpful in verifying the absence of blood flow on the affected side but it should not prevent prompt surgical exploration if torsion 1s suspected. REFERENCES
1. Lee, L. M., Wright, J . E. and McLoughlin, M. G.: T e s t i d torsion in the adult. J. Urol., 130 93,1983. 2. Witherington, R.and Jarrell, T. S.: Torsion of the spermatic in adults. J. Urol., 143: 62, 1990. 3. Patriquin, H.B., Yazbeck, S., Trinh, B., Jequier, S., Bums, p. N.* Grigron, A., Filiatrault, D., Garel, L. and Dubois, J.:Testicdu torsion in infants and children: diagnosis with Doppler SOnOgraphy. Radiology, 188: 781,1993.
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Vol. 154, 1480, October 1996 Printed in U.S&
TESTICULAR TORSION IN A 59-YEAR-OLD MAN THOMAS A. LONDERGAN From the Department
of
Urology, Gundersen Clinic, La Crosse, Wisconsin
KEYWORDS:testis, spermatic cord torsion, ultrasonography
We report on a 59-year-old man who presented with an acutely swollen, tender testicle. Color Doppler ultrasonography demonstrated no blood flow to the involved testicle. Scrotal exploration revealed 720-degree torsion of the spermatic cord and bilateral orchiopexy was performed. Spermatic cord torsion should be considered in all older men who present with acute scrotal pain. Color Doppler ultrasound can be helpful in confirming the diagnosis. CASE REPORT
A 59-year-old man presented with right scrotal and testicular pain 6 hours in duration. The pain had begun abruptly in the morning, and was constant and severe. He denied any voiding symptoms, or a history of pain or scrotal trauma. "he left testicle was nontender. On physical examination the right testicle was enlarged, fkm and extremely tender. "here was no hydmcele and the epididymis could not be palpated as separate from the testicle. There was no relief of pain with elevation (negative Prehn's sign) and no horizontal lie. The left scrotum and testicle were normal on examination. The prostate was small, symmetrical and nontender. Urinalysis was unremarkable. Color Doppler ultrasound of the scrotum using an Accuson 128 X P l O probe and a 7 MHz. linear transducer showed absence of blood flow to the right testicle with normal flow on the left side. Scrotal exploration revealed 720-degree intravaginal torsion of the right spermatic cord and a firm mottled testis (see figure). Torsion was reduced and orchiopexy was performed on the contralateral side. Right orchiopexy was then performed and the wound was closed. One week later the patient was essentially pain-free and both testes were palpably normal. DISCUSSION
Testicular torsion is generally thought to occur only in children and adolescents. Recent reports document that 26 to 39%of cases occur in men older than 21 years and up to 10% in those older than 30 years.1.2 Because of the rarity of this condition in older men and the relative prevalence of epididymitis as a cause of scrotal pain and swelling, most cases are misdiagnosed and ultimately result in orchiectomy or testicular atrophy. Three men who were older than our patient have reportedly had testicular torsion (62,68 and 69 years old, respectively). Testicular salvage was achieved in 1 of 3 of these cases. In all cases, including ours, torsion was intravaginal rather than extravaginal. Color Doppler ultrasonography has been shown to have an accuracy of greater than 90% in diagnosing testicular torsion.3 However, false-negative findings are possible using this test and surgical intervention should not be postponed or denied simply on the basis of negative ultrasound. In our case ultrasound did not delay surgical exploration and was accurate in showing the absence of blood flow to the affected testicle. Accepted for publication April 13,1995.
Exploration reveals 720-degree torsion of right spermatic cord CONCLUSIONS
Our case demonstrates that testicular torsion can OCCUT in an older man. History and physical examination remain the key to the diagnosis. Color Doppler ultrasound can be helpful in verifying the absence of blood flow on the affected side but it should not prevent prompt surgical exploration if torsion 1s suspected. REFERENCES
1. Lee, L. M., Wright, J . E. and McLoughlin, M. G.: T e s t i d torsion in the adult. J. Urol., 130 93,1983. 2. Witherington, R.and Jarrell, T. S.: Torsion of the spermatic in adults. J. Urol., 143: 62, 1990. 3. Patriquin, H.B., Yazbeck, S., Trinh, B., Jequier, S., Bums, p. N.* Grigron, A., Filiatrault, D., Garel, L. and Dubois, J.:Testicdu torsion in infants and children: diagnosis with Doppler SOnOgraphy. Radiology, 188: 781,1993.
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