Impact of Spermatic Cord Torsion on Testicular Structure and Function

Torsion of the spermatic cord is one of the most frequent causes of acute scrotum, with two well-defined incidence peaks: perinatal and pubertal. Testicular injuries are time-dependent, with a “golden window” for saving testicular function estimated as 4–8 h from the onset of symptoms. Although it was initially suggested that patients with a history of detorsion might have more significant alterations in their semen analysis than those who had undergone orchiectomy, this suggestion does not seem to be confirmed. Paternity rates decrease with advancing age at torsion, being high in patients with torsion in childhood, slightly decreased in patients who had torsion in puberty and lower with increasing age. Peculiar lesions secondary to torsion are observed in orchiectomy specimens, whether venous (thrombosis), arterial (arteriopathy obliterans), or neural (Morton-like neuroma). On two issues, there seems to be a consensus: (A) In old perinatal torsions, if the testicular remnants are located in the scrotal or inguinal position, surgery is unnecessary, and, (B), the solitary contralateral testis should be fixed to the scrotum to prevent anorchia.