Testicular Torsion

Overview

Testicular torsion is a condition in which a testicle becomes rotated. This rotation twists the spermatic cord, which delivers blood to the scrotum. The lack of blood flow produces swelling and intense pain. The condition typically occurs between ages 12 and 18, but cases can occur at any age.

In almost all cases, testicular torsion requires immediate emergency surgery to save the testicle. Without blood flow, the testicle quickly becomes damaged and can be lost if the damage is too severe.

The majority of cases occur in males with an inherited trait that allows for free rotation of the testicle within the scrotum. The trait can affect one or both testicles and predisposes men to testicular torsion. However, it is not the immediate cause.

Symptoms

The most prominent symptom of testicular torsion is sudden and intense pain in the scrotum. Other common symptoms of testicular torsion can include:

• Swelling of the scrotum
• Nausea or vomiting
• Fever
• Abdominal pain
• Irregular positioning of the testicle
• Frequent urination

Diagnosis

Testicular torsion is one of the first considerations when a patient comes in with significant pain in the scrotum. The physician can physically examine the scrotum, testicles, and groin to check for testicular torsion or other possible causes. They can also test the reflexes for testicular contraction, which may not occur in cases of testicular torsion.

Further testing can include a scrotal ultrasound that provides an image of blood flow to the scrotum. A urine test can check for other potential causes of the symptoms, like an infection.

In some cases where the pain is severe and has lasted for several hours already, a patient might be sent directly to surgery. That will quickly determine if the diagnosis is testicular torsion and give the best chance of saving the testicle.

Treatment

The treatment for testicular torsion is surgery to untwist the spermatic cord. While in some cases, a physician may be able to disentangle the testicle by manipulating the scrotum manually, surgery will still be required.

In most cases, the surgery is carried out under general anesthesia. It is generally a simple procedure in which the doctor makes a small incision in the scrotum. They then manually untwist the spermatic cord. In some cases, the doctor will stitch the testicles to the interior of the scrotum to prevent a recurrence of testicular torsion.

Testicular removal may be necessary. This risk increases as treatment is delayed, with chances of removal increasing sharply after six hours from the first occurrence of the pain.

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