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Testicular torsion is a serious medical emergency characterized by the twisting of the spermatic cord, which cuts off blood flow to the testicle. This sudden rotation causes intense pain and swelling due to the lack of blood supply. Testicular torsion typically occurs in individuals between the ages of 12 and 18, but it can happen at any stage of life, including before birth. Usually, only one testicle is affected. It is more frequently observed in the left testicle compared to the right.
Emergency surgery is typically necessary to resolve testicular torsion. Prompt treatment usually allows for the preservation of the affected testicle. However, if blood flow is blocked for an extended period, severe damage may occur, potentially leading to the necessity of testicle removal.
Symptoms
The following signs and symptoms of testicular torsion may include:
- Swelling of the scrotum
- Sudden and severe pain in the scrotum
- Discoloration (red, purple, brown, black) in your scrotum.
- One testicle is higher in your scrotum than the other.
- Abdominal pain
- Fever
- Frequent urination
- Nausea and vomiting
Testicular torsion in young boys usually causes scrotal pain that wakes them up in the middle of the night or early in the morning.
If you have sudden or severe testicular pain, seek immediate emergency attention. If you have testicular torsion, prompt treatment can save serious damage or possibly the loss of your testicle.
Additionally, you should get medical attention immediately if you experience unexpected testicular pain that goes away on its own. Intermittent torsion and detorsion, or the twisting and untwist of a testicle on its own. In order to keep the issue from recurring again, surgery is frequently required.
Causes
Testicular torsion is the result of the testicle rotating on the spermatic cord, which supplies the testicle with blood from the abdomen. Damage can occur more quickly if the testicle rotates multiple times because blood flow to it may be completely cut off.
The cause of testicular torsion is unknown. The majority of men who develop testicular torsion are born with a genetic characteristic that permits the testicle to freely rotate inside the scrotum. This inherited condition typically affects both testicles. However, not every male with the trait will experience testicular torsion.
Testicular torsion frequently happens when you’re sleeping, a few hours after intense physical activity, or following a minor testicular injury. Another factor could be the cold climate or the testicles’ quick growth during adolescence.
Risk factors
The following factors may increase the likelihood of testicular torsion.
- Age: The age range of 12 to 18 is the most common for testicular torsion.
- History of testicular torsion: Testicular pain that resolved spontaneously without treatment. (intermittent torsion and detorsion) is prone to recur. The likelihood of testicular injury increases with the frequency of pain episodes.
- The condition may also run in families.
Diagnosis
Testicular torsion can be diagnosed by a healthcare provider based on your symptoms, medical history, testicular examination, and scrotal ultrasound.
- Physical examination: In order to confirm if testicular torsion is the cause of your symptoms or something else, your healthcare provider will question you. Physical examinations of the scrotum, testicles, abdomen, and groin are frequently used by healthcare providers to identify testicular torsion.
Additionally, your healthcare provider may lightly press or pinch the inside of your thigh on the side that is affected to assess your reflexes. Usually, this results in the testicle contracting. If you have torsion in your testicles, this response might not happen.
- Scrotal ultrasound: Blood flow is monitored using this kind of ultrasonography. Testicular torsion is indicated by decreased blood flow to the testicle. However, testicular torsion may not always be ruled out by ultrasound since the diminished blood flow is not always visible.
- Urine test: This examination looks for infections.
- Surgery: To rule out other conditions or testicular torsion as the cause of your symptoms, surgery may be required.
You may be sent straight to surgery without further testing if your physical examination indicates that you have testicular torsion and you have been in pain for several hours. If surgery is postponed, testicle loss may occur.
Treatment
Testicular torsion must be corrected surgically. In some cases, the healthcare provider may be able to do a manual detorsion—pressing on the scrotum—to untwist the testicle. However, surgery will still be required to keep the torsion from happening again.
Testicular torsion surgery is called orchiopexy. This is often performed under general anesthesia. The healthcare provider will make a little incision in your scrotum during the procedure, untwist your spermatic cord if required, and stitch one or both testicles to the inside of the scrotum.
The testicle has a better chance of survival the sooner it is untwisted. There is an increase in the likelihood of requiring testicle removal six hours after the pain first appears. If treatment is delayed for more than 12 hours after the onset of pain, there is at least a 75 percent chance that removal of the testicle will be necessary.
Although it’s uncommon, testicular torsion can happen to newborns and infants. The testicles of the baby may be firm, enlarged, or have a darker hue. Surgery might be required to confirm testicular torsion since ultrasound may not be able to identify decreased blood flow to the infant’s scrotum.
The management of infant testicular torsion remains a topic of debate. When symptoms and signs of testicular torsion are present in a newborn, the use of general anesthesia poses risks, and emergency surgery may not always be immediately feasible. Nevertheless, urgent surgical intervention, when possible, can potentially salvage part or all of the affected testicle and prevent damage to the other testicle. Early treatment of newborns with testicular torsion may help prevent future complications related to male hormone production and fertility.
