Histopathological Findings of Testis Torsion According to Parenchymal Regions: New Recommendations for Damage Detection and Future Directions

Abstract

Testis torsion is a scrotal emergency in which parenchymal damage cannot be accurately predicted. This situation leads to atrophy in the follow-up of patients who underwent orchidopexy, and potentially reversible injury can be detected in the orchiectomy series. This study aimed to find answers to questions about the accurate detection of testes with potentially reversible injury. The testes of patients who underwent orchiectomy due to testis torsion under the age of 35 (n = 54) were re-examined. Considering the vascular anatomy of the testis, necrotic changes in the epididymal, anti-epididymal, and central regions were scored from grade 1 to 3. The necrosis score was obtained by multiplying the degree and percentage of necrotic areas. Potentially reversible injury (Grade 1) was detected in 10 (18%) testes, and 3 of them had partial necrotic changes. Grade 1 injury could be detected after a symptom duration of up to 168 h, while grade 3 could be observed after as short as 6 h. The median symptom duration of Grade 3 necrosis was higher than that of Grade 1 and Grade 2, but this difference was not statistically significant (P = .066). Testis pain, swelling, and abdominal pain were most commonly seen in high-grade injuries (P = .047). The highest necrosis scores were observed in the central region of the testes, followed by the epididymal and anti-epididymal side (P = .035). Clarification of the injury pattern of the twisted testes will allow a more accurate estimation of parenchymal damage and salvage ability.