Testicular torsion is a medical emergency that should be treated immediately in order to avoid irreparable damage to its affected testicle. While most testicular torsion cases occur among adolescents during puberty, newborns and older adults can also suffer this fateful fate.
Painful swelling on one side of the scrotum is typically the telltale symptom, and healthcare providers can diagnose this condition via physical examination, ultrasound imaging and medical history review.
Symptoms
Testicular torsion symptoms can be sudden and severe. They arise when one of the cords providing blood to one or both testicles becomes twisted, cutting off its supply, causing swelling in the scrotum and testes, pain in the scrotum and testes, as well as sudden, severe pain. Treating testicular torsion as soon as possible is essential – waiting may reduce chances of saving a testicle significantly.
Boys should seek medical help immediately for any painful and swollen testicles, even if it causes them embarrassment. Any pain in the groin must be taken seriously and treated within six hours for maximum chance of saving a testicle.
Blood flows to each testicle through two long, thin tubes known as spermatic cords (or testicular cords). These cords connect them to pouches on either side of the penis known as scrotum pouches. If a boy experiences testicular torsion, his spermatic cords become twisted within his scrotum pouch and cut off blood supply to that testicle, leading to its shrinking and possible death; doctors can usually save this testicle if untwisted within six hours after symptoms appear but chances of saving it diminish over time.
Urologists (and pediatric urologists) specialize in treating testicular torsion. Through surgery, urologists can untwist and restore blood flow to testicles that have become torsioned; ideally this would take place in an emergency room setting before worsening sets in; otherwise the chance of saving one drops by 10-20% after six hours has elapsed since symptoms first surfaced.
Once surgery has taken place, a urologist will stitch together the scrotum and testicle, taking strict return precautions – this includes not participating in sports activities such as playing baseball – to prevent further strain to either. If sexually active boys wish to return to fathering children again they should consult their physician to establish when it will be safe. For boys suffering from torsion of their testicle they may consider having it replaced with an artificial one instead.
Diagnosis
Testicular torsion can be difficult to identify due to its similar symptoms to epididymitis. Both conditions cause acute unilateral scrotal pain, swelling, and tenderness; their primary problem being that their spermatic cord has become entangled, restricting blood supply to their testicles.
Healthcare professionals should perform an examination of the scrotum, testicles and abdomen as well as query about recent symptoms to accurately diagnose torsion. In addition, cremasteric reflex testing by lightly pressing or rubbing on one testicle causes its flex and contract mechanism – something typically absent with torsion.
Anyone suspected of torsion should immediately seek evaluation by emergency medical services (EMS). Ideally, this should happen within six hours from when symptoms first appeared; each hour that passes without treatment decreases your chance of saving your testicle.
EMS staff should immediately recognize signs of torsion and contact an urgent urology consultation, making arrangements to administer NPO as soon as possible, and conducting all relevant blood work tests. A urologist will attempt to unwind the spermatic cord in an emergency room setting before considering surgical removal (orchidectomy) as a potential solution.
Torsion requires surgery in all cases. As well as restoring blood flow to the spermatic cord, a urologist will often insert stitches through the scrotum in order to prevent further twisting and torsion of testicles that have become knotted up over time. Sometimes even large or long testicles require this additional measure.
Torsion of a testicle can result in permanent damage if it is left untwisted for too long, even when untwisting is performed as soon as possible. Even when surviving initial trauma, blood flow decreases beyond six hours can hinder its function causing it to eventually shrink and require surgical removal from the scrotum (orchiectomy), leading to decreased fertility in men.
Treatment
Testicular torsion occurs when a man’s testicle twists inward, cutting off blood flow to it and leading to swelling. This condition should be considered an urgent medical matter that must be dealt with quickly to avoid infertility and other complications; otherwise, viability of the affected testicle declines rapidly and it may need surgical removal as soon as it continues.
Since symptoms of testicular torsion resemble those of epididymitis, doctors must maintain a high index of suspicion to quickly diagnose it. They typically perform a physical exam of the scrotum, testicles and abdomen/groin of patients exhibiting torsion symptoms and perform other diagnostic procedures like lightly rubbing their scrotum or pinching an inner thigh on affected side which should help cause testicles to contract; for additional assistance a urologist can order urine tests to check for signs of infection as well as ultrasound scans of their scrotum/abdomen.
Torsion in one or both testicles typically manifests itself, though bilateral torsion is possible and can lead to more serious erectile dysfunction issues. Your chances of saving a testicle significantly increase if its torsion has only been present for six hours or less; otherwise its blood supply could become cutoff and necessitate surgery to extract it.
Urologists typically have the ability to untwist and restore blood flow through spermatic cords during surgery. The procedure usually occurs under general anesthesia and patients usually return home shortly afterwards. Rarely, physicians may be able to manually detorsion (push on detorsion) your testicle back into its proper position; however, this usually doesn’t prevent further torsion and surgery is typically needed as a solution in these instances. Operative care typically falls to a urologist; however, an orthopedic surgeon or another specialist may also perform it. Doctors may stitch the testicle back onto its position in the scrotum after stitching it back and may perform a biopsy to check for tissue damage or abnormal growths on affected testicles.
Prevention
Importantly, boys should be encouraged to immediately inform a parent or other adult of any pain in the scrotum or testicles – rather than attempting to “walk it off.”
Testicular torsion occurs when one or both testicles become inflamed from their blood supply being cut off resulting in sudden pain, swelling and reddening in the scrotum area. This condition can also result in sudden periods of incontinence affecting sexual performance and reproduction.
Most people who suffer from this condition do not report experiencing trauma to their testicles or scrotum prior to experiencing symptoms, although intensive exercise or injury in the groin could contribute. People who have already been affected might have an increased risk for it reoccurring.
This issue can lead to severe damage if left untreated promptly, with chances of saving a testicle significantly decreasing after six hours if no action are taken quickly. To restore blood flow back into a testicle (detorsion), physicians in emergency rooms (detorsion) may untwist cords; but surgery by an urologist (specialist in kidneys, bladders and ureters) is often necessary as they will place stitches to keep it from twisting again.
If a person does not seek immediate surgery, his entire testicle could need to be surgically removed (“orchiectomy”). Although any remaining testicle will continue producing sperm, its production won’t grow as large and might not be as powerful. Following such surgery, some boys might opt for prosthetic (artificial) testicles as replacement.
Men and boys assigned male at birth are born with two testicles that serve as their reproductive organs; these testicles hang below the penis known as the scrotum and produce hormones and sperm production. A spermatic cord connects these testicles to other parts of their bodies while holding them securely; any twist in it could disrupt blood supply to a testicle causing its death.
