A review of main controversial aspects of acute testicular torsion

Testicular torsion (TT) is a severe acute urological emergency caused by twisting of the spermatic cord. It requires prompt diagnosis and treatment. Unfortunately, its importance is still underestimated in everyday life: early-detected TT can be cured in almost every case, whereas late identification may lead to loss of the testicles. We present a comprehensive review of TT, including the aetiology, risk factors, diagnosis, treatment and outcome, based on recently published articles. The novel and the major controversial aspects of this topic are highlighted. The PubMed and ScienceDirect databases were searched with the following keywords: TT, torsion of the spermatic cord and acute scrotum, particular stress being placed on articles published in the last 5 years. The genetic aspects of TT are discussed, together with the diagnostic possibilities, such as sonography, radionuclide and fluorescent imaging techniques. The effective surgical techniques and potential drugs for reducing molecular injuries were surveyed. Finally, the major controversial aspects of TT are considered. The new concepts of TT demonstrate that certain features remain unclear. New, more accurate diagnostic tools and prompt management may contribute to a better prognosis and prevent the loss of the testicles.