Anatomical risk factors for spermatic cord torsion and their involvement in the choice of orchidopexy technique

• Published in: Morphologie 2021-02, Vol.105 (348), p.1-9
• Main Authors: Beaud, Nicolas, Kanbar, Anthony, Abdessater, Maher
• Format: Article
• Language: English
• Subjects: Anatomy; Fixation; Orchidopexy; Spermatic cord; Testis; Torsion
• ISSN: 1286-0115
• DOI: 10.1016/j.morpho.2020.06.006

•Anatomical predispositions for spermatic cord torsion: High insertion of the tunica vaginalis, a long mesorchium, deficient attachment of the epididymis to the testis, and anomalies of the gubernaculum testis.•Surgical fixations techniques: conventional technique by triangulation with or without fasciotomy, window orchidopexy, scrotal pouch, and vaginal eversion with or without Dartos fixation.•The most common anatomical factor associated with spermatic cord torsion is the high insertion of the tunica vaginalis.•Vaginal eversion with fixation to the Dartos muscle might be superior to other surgical techniques.•This technique seems promising to become the standard treatment of spermatic cord torsion. We aim by this article to present a literature review on the anatomical risk factors for spermatic cord torsion and their involvement the different techniques of orchidopexy. The literature review was conducted following PRISMA check-list, using PubMed database and the Mesh terms: testis, torsion, anomaly, orchidopexy. Techniques of surgical management provided by the EMC (French medico-surgical encyclopedia) were also used. Database research identified 500 articles, and 16 mores articles were added from the review of the references lists of relevant articles. At the end, 42 articles were useful for our review including 6 reviews, 5 cross-sectional studies, 14 cohorts, 10 case reports, 1 meta-analysis, 1 letter, and 5 experimental studies. High insertion of the tunica vaginalis, a long mesorchium, deficient attachment of the epididymis to the testis, and anomalies of the gubernaculum testis are the anatomical predispositions for spermatic cord torsion. After reduction of torsion, many surgical techniques for the fixation of the testis have been suggested including: conventional technique by triangulation with or without fasciotomy, window orchidopexy, scrotal pouch, and vaginal eversion with or without dartos fixation. The most common anatomical factor associated with spermatic cord torsion is the high insertion of the tunica vaginalis. Vaginal eversion with fixation to the dartos might be superior to other known techniques and seems promising to become standard. Nous présentons une revue de la littérature sur les facteurs de risque anatomiques de la torsion du cordon spermatique et leur implication dans les différentes techniques d’orchidopexie. La revue de la littérature a été réalisée selon la stratégie PRISMA en utilisant la base de donnée PubMed et les te