1. Testis torsion in undescended testis
Journal of pediatric urology(2013) 9, 793-797
Journal of emergency medicine, (2012) 42, 5, 538-539
Journal of urology 2006 Jun;175(6):2287-9

2. 8-15wks fetus
CSL regression
Gubernaculum pull down
Insulin like factor by leydig cell
AMH(MIS)
25-35wks fetus
Androgen, genito-femoral n.
>>calcitonin gene related peptide
Limb bud “progress zone”

3. • Undescended testis in full term:3.5%
– Prevalence in 1 y/o: 1%
– 75% in the inguinal canal
• Torsion in cryptorchidism
–23%testis torsion
– Risk: 10X
– Salvage rate: 10% (56% in pure torsion)

4. Diagnosis
• S/S
– Child unexplained groin/abd pain
– Tender groin with swelling +/- mass
– Ipsilateral hemiscrotum
• Workup
– Echo
– explorative

6. Lt scrotum: empty
Heterogenous testis
texture
No flow in testis
But surrounding hyperemic
D/D: incarcerated hernia

7. MECHANISM?
• ?
• NTD with UD, abnormal contraction/spasm of
Cremasteric m.
– Black entrance to scrotum
• Especially in the Cerebral palsy and neuromuscular
disease child

8. Key concepts
• Testis torsion in UDT is not uncommon
–Delayed Dx make low salvage rate
• Abdominal pain in children
–Empty scrotum?
–Inguinal mass?
–D/D incarcerated hernia? Colic pain?