Diagnosis and outcome of testicular torsion

In a prospective study of 80 patients with acute testicular pain, static and dynamic scans of the scrotum were obtained by radionuclide imaging. Seven patients with acute testicular torsion were identified by gross reductions in isotope uptake. Enhanced uptake (indicating hyperaemia) was seen in 37 patients with acute epididymitis, testicular tumour or resolved torsion. Late torsion and some tumours demonstrated a "halo' sign, with central necrosis and a peripheral increase in blood supply. A group of 22 patients with previous orchidopexy for torsion was reviewed 2-5 years postoperatively. In 15 the previously twisted testis was greater than 10 per cent smaller than its opposite member and 12 patients showed severe abnormalities of seminal analysis. Hormonal profiles were generally normal. Retention of testes damaged by ischaemia may risk autoimmunization against spermatogenesis.