Anatomic aspects of epididymis and tunica vaginalis in patients with testicular torsion

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Abstract
Objective: To analyze the morphology of epididymis and tunica vaginalis as well as their anatomical anomalies in patients with testicular torsion. Materials and Methods: We studied 25 patients (50 testes) aged between 12 and 23 years (mean 15.6). Torsion length ranged from 2 hours to 2 days (mean 8 hours). Epididymal anatomy was classified in 6 groups: Type I - epididymis united to the testis by its head and tail; Type II - epididymis totally united to the testis; Type III - disjunction of epididymal tail; Type IV - disjunction of epididy- mal head; Type V - total disjunction between testis and epididymis, and Type VI - epididymal atresia. The type of torsion was classified in 3 groups: Group A - intravaginal torsion; Group B - extravaginal torsion and Group C - torsion due to long mesorchium. Results: Of the 50 analyzed testes, 40 (80%) presented bell clapper deformity (with 21 pre- senting intravaginal torsion); 8 testes (16%) had long mesorchium (4 with torsion), and only 2 (4%) presented normal anatomy in the tunica vaginalis. The most frequently found anatomical relationship between testis and epididymis was Type I - 38 cases (76%); Type II relationship was found in 6 cases (12%) and Type III relationship was found in 6 cases (12%). Conclusions: Intravaginal torsion is the most frequent type, and torsion due to long mesor- chium is associated with cryptorchism. The most frequently found anatomical relation between testis and epididymis in the study group was Type I.

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