Is Spermatic Cord Torsion Exclusively an Adolescent Emergency?

Abstract

Testicular torsion is a surgical emergency defined as the torsion of the spermatic cord in the tunica vaginalis. It occurs mainly in adolescents. Beyond 6th hours, irreversible lesions start to appear. Therefore, the prognosis of the testicle will depend on the time taken to treat it. The main differential diagnoses are torsion of the testicular appendages and orchiepididymitis. In adults, it poses a diagnostic problem leading to a high rate of orchiectomy. We are reporting a 46-years old patient with a history of recurrent urethritis and orchiepididymitis who came with scrotal pain associated with fever and urinary tract symptomes  in whom the diagnosis of a neglected testicular torsion was made.  Surgical exploration found a necrotic testicle with the presence of spermatic cord twist. An orchiectomy was performed. The postoperative follow up was simple. With this case, the authors remind us that testicular torsion is a real urological emergency that requires a race against time. Whatever the age and the history, it must be the first diagnosis to be evoked (until proven otherwise) in front of any acute scrotam seen in the emergency.