Testicular torsion requires immediate medical treatment. Significant groin pain may indicate this medical emergency.
Surgery may be necessary to untwist and restore blood flow through the spermatic cord and prevent future torsion. This procedure should be conducted while under general anesthesia for best results and to protect future torsions.
Diagnosis
Testicular torsion can be diagnosed through history, symptoms and physical exam. Common signs and symptoms include sudden severe pain in one testicle, nausea and vomiting as well as swollen scrotum with affected testis elevated and horizontal; cremasteric reflex typically absent on this side; doppler ultrasound of erectile tissue to determine blood flow may help determine this diagnosis; no blood flow or paleness indicate potential torsion.
If someone experiences this condition, the emergency department should be consulted immediately. Once there, doctors will perform a physical exam of the scrotum, testicles and abdomen as well as conduct urine tests to detect infection in the area. A urologist can then be called in to assess and treat as needed.
Doctors conducting an adnexal torsion diagnosis for adolescents will ask when symptoms first appeared and how often they recur, in addition to asking if anyone in their family has experienced similar difficulties and whether this condition can be hereditary.
This disorder affects those between 1-25, and most often appears during prenatal period and puberty. Both males and females can be affected by it although males seem more prone than their counterparts.
Adnexal torsion in adults may be rare, but when it occurs it can be extremely serious. Adnexal torsion occurs when either an ovary or its fallopian tube become twisted causing its blood supply to be cut off – an urgent medical emergency that must be dealt with quickly for proper recovery. If left untreated it could prove fatal.
Adnexal torsion symptoms resemble those of testicular torsion and include abdominal pain, nausea and vomiting, swollen abdomen and fever/shivering. A urologist may perform manual detorsion to restore blood flow by placing the patient supine and rotating their testicle away from its midline; typically two or three complete rotations will untwist their ovary and restore blood flow.
Symptoms
Testicular torsion symptoms vary but usually include pain in the scrotum, nausea and vomiting, and a bulging appearance on an affected testicle. Left untreated, testicular torsion could lead to blood flow blockage within its testicle that could result in permanent damage and infertility; therefore it should be addressed as quickly as possible as this condition constitutes a medical emergency and treatment should begin immediately.
Testicular torsion occurs when the cord that supplies blood to the testes twists, cutting off its supply. According to Cleveland Clinic, this can result in intense, immediate pain in the scrotum as well as swelling and bulging on one side of the affected side. It is important to distinguish this condition from others that could present similar symptoms, including epididymitis, orchitis and scrotal hematoma.
Young boys suffering from testicular torsion often awaken in the middle of the night or early morning with scrotal pain, and should seek immediate medical attention as the pain may subside quickly indicating that blood flow to their spermatic cord has not completely ceased.
Doctors typically conduct a physical exam of the scrotum, testicles and abdomen to diagnose an individual. A urologist may additionally perform a urine test to see if dehydration exists in their patient.
If torsion is identified early enough, a urologist can manually untwist the cord and restore blood flow to the testicle. Usually performed in an emergency room setting, patients experience dramatic relief within minutes following this procedure. Ultrasound technology may be utilized during this procedure to guide and verify whether blood circulation has returned.
People suffering from testicular torsion should refrain from engaging in strenuous activity and sexual activity for some weeks after surgery, or they risk further damaging the testicle by engaging in strenuous activities and sexual activity too soon afterward. If one testicle loses its blood supply for longer than six hours, orchiectomy surgery may be required and both testicle can usually still be used as fatherly organs – although some boys choose an artificial testicle instead if one organ is lost.
Treatment
Anyone suspecting testicular torsion should visit an emergency room immediately. They will need to lie supine so their physician can inspect their scrotum, abdomen and groin areas in detail before asking questions about pain levels and any associated symptoms, such as whether or not the pain comes and goes or causes nausea/vomiting/how long has this pain been ongoing. They may also receive a urine test as part of this evaluation process.
If a testicular torsion is detected early, a urologist can use manual detorsion to restore blood flow. They will have their patient lie down while holding one hand; then rotate their affected testicle, as though opening a book. Usually this relieves pain quickly and blood will return within minutes – then ultrasound of both scrotum and testicle will reveal whether both pieces have become completely or partially twisted.
Mild cases of torsion may not require treatment; for most however, their testicle will need to be surgically untwisting – this usually takes place as an outpatient procedure and the patient receives painkiller and general anesthesia so they won’t feel anything during this process. A surgeon will make a small cut in the scrotum before untangling their testicle from its twist in spermatic cord and stitching it back onto scrotum permanently to avoid future torsion episodes.
On rare occasions, urologists may need to perform orchiectomy on men to reduce hormone production in infants and decrease sperm count in men. If this happens, it could disrupt hormone production for infants while also decreasing sperm count for men.
Ovarian torsion is much less prevalent than testicular torsion and usually only affects women during their reproductive years, such as those using fertility treatments that result in cysts or masses forming on their ovaries. Women experiencing severe life-threatening pain from such cysts and masses could lead to sepsis and possibly death without treatment.
Prevention
As soon as your son experiences any increase in scrotal pain, encourage him to inform an adult right away so he can seek medical help immediately. Untwisting it within 6 hours after symptoms appear can help your testicle remain intact – otherwise it may lose function and need surgical removal.
Torsion in newborn boys may be avoided in certain instances by having the urologist who delivers the baby perform a manual detorsion as soon as possible after birth, grasping and rotating away from midline as though opening a book, in order to restore blood flow back into affected testicle(s). This usually restores circulation back into affected testicle(s).
Boys with this testicular condition should also be encouraged to seek regular checkups with a pediatric urologist for a scrotal ultrasound exam, even if no issues have arisen in the past. A scrotal ultrasound exam can determine if their testicle is vulnerable to twisting and detect problems like cysts or teratomas – rare but pain-inducing conditions which mimic symptoms associated with testicular torsion.
If a torsion of an adolescent’s testicle is diagnosed on clinical grounds, surgery should be carried out promptly after diagnosis. This may involve placing an IV in their arm or hand and giving analgesic medications before trying to untwist their testicle. Delay in treatment increases the amount of time that blood supply to affected testicle is cut off, decreasing chances of survival; to ensure timely assessment and treatment a standardized care pathway must be developed that ensures patients receive timely assessments and treatments – as well as minimizing delays when moving between health care facilities or hospitals within hospitals themselves.
At the time of surgery, one testicle should be tacked securely into place to prevent it from twisting in the future. Even if one testicle loses sperm production altogether, this should not impact his ability to father children in any way.
