Testicular torsion occurs when the spermatic cord that supports the testicle in the scrotum twists, cutting off blood flow to it and leading to its demise – an extremely serious complication.
Should you experience sudden testicle pain, seek medical attention immediately to preserve and avoid permanent damage to the testicle. In many instances surgical removal will likely be necessary.
Symptoms
Testicular pain can be a serious health risk. If it affects you, seek medical advice as soon as possible as it could indicate something serious that needs attention or may even be life-threatening.
Testicular torsion occurs when the spermatic cord (which holds testicles in the scrotum) twists inward, cutting off blood flow to an individual testicle and leading to permanent damage and in extreme cases even death of that testicle. Treatment should be sought as soon as possible as lack of blood can lead to permanent damage and even cause it to die off entirely. Torsion occurs most frequently among infants or adolescents entering puberty (beginning age 12-13), although it can affect anyone at any age; spontaneous events tend to happen more often on one testicle than its counterpart on either side, usually on one testicle rather than both sides at once.
Testicular torsion manifests itself with sudden, extreme tenderness in the testicle area. There may also be swelling of the scrotum, nausea or vomiting and you could find yourself unable to produce urine as well as having an abnormal scrotal exam.
Your healthcare provider will perform a physical examination on both your scrotum and genital area, gathering details on any prior medical conditions and when pain started occurring. If they suspect a torsion is present, they may refer you immediately to an urologist for treatment.
Urologists use ultrasound of the scrotum and examination of your genital area to diagnose testicular torsion. They will also perform a cremasteric reflex test – meaning your body can sense when someone touches your spermatic cord – which could provide insight into any problems with your fertility.
Surgery may be necessary to untwist and restore blood flow to the spermatic cord and restore it, with optimal results being seen within six hours of initial symptoms appearing. Otherwise, testicle removal (orchiectomy) might become necessary; alternatively gonal diversion surgery might prevent future torsion; in such instances a scrotum support device or stitches from your urologist can prevent future torsion of that affected testicle from torsion occurring again.
Diagnosis
The testicles are two organs located within a pouch of skin known as the scrotum and produce male sperm and testosterone for male reproduction. Each testicle receives its blood supply through its own individual spermatic cord which connects each testicle directly to its respective scrotum. When this cord becomes twisted it cuts off blood flow to one or more testicles resulting in painful swelling within the scrotum requiring immediate medical intervention to avoid permanent damage to those organs.
Testicular torsion manifests itself with sudden, intense pain in one testicle that occurs suddenly and without warning. This discomfort may strike while awake, sleeping, sitting or active and it can get worse when touching or moving the scrotum.
If you or your child exhibit symptoms of testicular torsion, contact an ambulance or hospital immediately. A healthcare provider will examine you and perform a scrotal ultrasound; this test can show whether there are issues with either your spermatic cord or blood flow to the testicle.
Healthcare providers may attempt to manually detorsion a patient by grasping their affected testicle and turning it as though opening a book, in an effort to restore blood flow and relieve their pain. This technique typically works within 30 seconds, with patients reporting significant improvement within minutes – this technique may even work when done in the emergency department (ED) or operating room (OR).
If one or both testicles cannot be untwisted through untorsion techniques alone, surgical removal will likely be necessary in order to restore blood flow to both testicles and allow them to function normally again. A surgeon can stitch the scrotum and repair the spermatic cord before performing orchiopexy to attach one testicle directly onto it in order to avoid future torsion.
If your index of suspicion indicates torsion, it’s wise to seek expert consultation as soon as possible with a urologist, even before receiving an ultrasound scan. Doing so can save time on unnecessary imaging if surgical consultation becomes necessary and help minimize tissue loss due to delayed diagnosis and treatment.
Treatment
Testicular torsion is a medical emergency as it cuts off the blood supply to the testicle. Torsion occurs when the spermatic cord, which supports the testis in the scrotum, becomes twisted and stops blood flowing to it, leading to atrophy of its size and shrinkage of its volume. If untwisted within six hours it may lead to death of its host organ – typically young males during puberty but also newborn babies or older adults.
As soon as possible, patients should be taken to a hospital. For optimal treatment this means calling in an expert in urology for guidance and getting an urgent ultrasound. A urologist can use Doppler ultrasonography to measure arterial and venous blood flow to the testicle – with arterial flow showing as peaks on its Doppler waveform while venous flow shows plateaus – and determine its severity or viability.
If a testicle is no longer viable, surgical removal must occur through orchiectomy. To accomplish this procedure, the surgeon will make a small cut in the scrotum and untwist the spermatic cord before unwinding it again. If further torsion risk exists, orchiopexy may also be performed to help protect against future twisting of the testicle.
Some individuals may experience chronic discomfort that does not go away, which could indicate torsion is not being addressed properly and could become life-threatening. Anyone experiencing this sort of pain should contact an emergency room immediately for treatment.
ER staff should assess airway, breathing and circulation before prepping patients for surgery. This involves getting them NPO (nil per oral) before getting all blood work completed; nurses should administer an IV to help relieve pain and nausea; in case a torsion has already taken hold, surgical removal (orchiectomy) of affected testis must occur within days; otherwise other at risk testis might need connecting via orchidectomy procedure.
Prevention
Testicular torsion occurs when the spermatic cord connecting two testicles becomes twisted, cutting off blood flow to one or both testicles and potentially killing them. It typically affects people aged 12-18, often without an apparent cause – it could occur following strenuous exercise, during sleep or when playing sports – making it the most frequently occurring emergency of genital area among children and adolescents.
Testicular torsion typically presents itself in the form of severe pain in one testicle, sometimes to such an extreme that it causes nausea or is felt elsewhere in the stomach or can even make you queasy. While pain may come and go over time, often worsening over time. A doctor can diagnose this condition through physical exam and questioning about symptoms.
Many cases of testicular torsion occur among people who suffer from the genetic condition known as bell clapper deformity. Under normal circumstances, testicles attach directly to the scrotum. But those living with bell clapper deformity have unattached testicles which move freely within their scrotums like bell clapper deformities do – and so easily twist. This freedom makes twisting possible and many cases of torsion take place as a result.
Most men who experience torsion can still have their testicle saved, especially if surgery is completed within 6 hours after it starts. But if its blood supply is cut off for too long, the testicle will stop working altogether and may need to be removed (orchiectomy). Most individuals who lose a testicle due to torsion still have children and live normal lives; such individuals will simply require orchiectomy surgery rather than other forms of removal surgery in the future.
To prevent testicular torsion, it’s important to seek medical assistance immediately if symptoms appear, preferring the hospital over urgent care clinics. Also wear a spermicide cup during any contact or high-impact sports as this may help minimize injury to your scrotum and therefore testicular torsion. Also be familiar with its signs and symptoms so as to recognize early treatment needs and seek immediate assistance from medical providers.
