Etiopathogenesis (Torsion of the Testis)

Figure skro_2a_n.jpg and skro_2b_n.jpg: Operative findings in a 16.7- year-old boy with a left scrotal revision. skro_2a_n.jpg: The left spermatic cord is twisted in a clockwise direction. The turn-up of the opened and stretched tunica vaginalis by three forceps is located high on the spermatic cord. skro_2b_n.jpg: The turn-up is even better recognizable after re-torsion of the spermatic cord in a counter-clockwise direction. Now the epididymis is visible, too. skro_2a_n.jpg and skro_2b_n.jpg: In intravaginal torsion of the testis there is a high insertion of the testicular sheath which is also true for the contralateral side. ( $$skro_1??££ picture for comparison§§ drawing to the right§§). This variability or anomaly of the site of insertion predisposes to a torsion of the testis (clapper type of insertion because the testis and the beginning of the spematic cord lies within the testicular sheats like a clapper of a bell). It explains why a torsion may occur later on the other side, too. Depending on the amount of torsion in a clockwise or counter-clockwise direction and the duration of torsion up to its operative release the testis undergoes a differently severe ischemic damage. Nevertheless, there are indications that in candidates who have a predisposition for torsion already histological changes are present similar to those in cryptorchidism; this observation seems to determine the prognosis of fertility in addition to the direct sequels of torsion.