Torsion occurs when your spermatic cord twists, cutting off blood flow to one of your testicles. This is an urgent medical condition and must be attended to immediately.
Your next step should be consulting a urologist. He or she can perform surgery to untwist your spermatic cord and restore blood flow back into your testicle.
Diagnosis
Testicular torsion is a medical emergency that must be diagnosed quickly. This condition occurs when one or both testicles become twisted, cutting off its blood supply and necessitating immediate surgery; every hour that passes decreases chances of saving it; restoration of blood flow within six hours will increase its likelihood.
Testicular torsion symptoms typically include acute, sharp pain in the scrotum (pictured left) and swelling. Sometimes this pain is so intense it prevents one from standing or sitting up; when this happens it’s critical that an ultrasound be completed as quickly as possible; calling a urologist immediately is the key step in treating torsion.
Urologists will assess your scrotum, testicles, abdomen and blood flow using tests like urinalysis and ultrasound imaging to monitor any pain that has emerged or to check how well blood flows to those areas. They may ask when it began and its severity. In addition, tests such as these can also provide valuable insights.
An ultrasound can provide the best way to diagnose testicular torsion, though its results may not always be clear. A twisted testicle may appear normal on an ultrasound scan or it could show no blood flow at all or an abnormally high resistance pattern of blood flow; furthermore, distinguishing between testicular torsion and epididymitis may be difficult.
Both conditions can cause symptoms that resemble each other in terms of pain, swelling and tenderness in the scrotum. Epididymitis tends to be less painful as its discomfort tends to be localized to just its epididymis itself. A urologist can distinguish between the two by viewing ultrasound or radioisotope scan images of your scrotal contents.
Urologists can manually untwist twisted testicles using orchiopexy. After this procedure is performed on damaged tissue, repair can be made so it doesn’t twist again – recommended when suspected torsion has occurred – making sure patients receive timely surgical referrals with effective and appropriate treatments without being delayed by diagnostic imaging procedures.
Treatment
Torsion of the testes is an emergency condition caused by twisting or rotation of the spermatic cord supporting them in the scrotum, cutting off blood supply to them and leading to permanent damage. Pain and swelling typically become intense rapidly. If left untreated promptly it may result in testicular hernia or Fournier’s Gangrene among other complications; typically there is four to eight hour window where untwisting can save testicle.
Testicular torsion symptoms may emerge suddenly during sports, physical activity or sleep and be painful enough to cause nausea and vomiting. Over time, however, the pain tends to intensify further until eventually spreading to the lower abdomen (tummy). If someone experiences such severe and sudden symptoms it is crucial that they seek medical help immediately.
Testicular torsion can be diagnosed using various tests such as ultrasound or CT scan; however, these assessments don’t always give an accurate picture and shouldn’t be seen as an alternative to surgical exploration and manual detorsion if necessary. If an ultrasound test or CT scan indicates torsion symptoms in someone, further medical interventions must take place immediately to detorn them and make a definitive diagnosis.
Confronting any discomfort in your scrotum may feel embarrassing, but it’s essential that any serious discomfort be reported to someone. Ignoring it or hoping it goes away may only worsen its intensity or damage your testicle permanently. If your discomfort isn’t caused by torsion, doctors can treat it using a procedure known as orchiopexy to repair it.
Surgery to treat testicular torsion generally entails using stitches to attach the testicle to the scrotum under anesthesia and without hospital stay, using stitches as needed to connect testicular tissue to its new home in the scrotum. Such surgery helps prevent future episodes of torsion as well as lower risks of testicular cancer. Urologists or nephrologists are the ideal healthcare providers to address testicular torsion since these specialists specialize in conditions related to urinary tract health and reproductive system healthcare conditions.
Preparation for Surgery
Testicular torsion occurs when the spermatic cord (the long, thin tubes that supply each testicle with blood) becomes twisted within your scrotum and cuts off its blood supply, leaving only six hours for treatment to restore blood flow to the testicle or risk having it shrink and die. Without treatment within this window of time, its blood supply could become cut off completely. You must seek medical care immediately in order to untwist and restore blood flow before any irreparable damage to either testicle occurs resulting in shrinkage or death of one of them!
Doctors typically diagnose this condition through physical examination of both symptoms and body structures. They’ll carefully look over your scrotum, testicles, abdomen, groin area as well as asking about when pain first started and any associated triggers. Cremasteric reflex testing – whereby gentle tugs on your crotch cause one testicle to contract in response – can help determine if testicular torsion may be responsible – can also provide valuable clues as to its source.
An ultrasound may be used to confirm a diagnosis of testicular torsion. It allows physicians to observe how a person’s testicle has been affected, and whether there’s still blood flow through their affected testicle. Doppler ultrasound allows physicians to check both arterial and venous blood flow intensity; arterial flow will produce spikes on their waveform, while venous flow produces more of a plateau effect on its Doppler waveform.
Wear loose-fitting pants and a shirt that can be pulled up or down easily. Bring along identification and insurance information as well as payment for any portion of the surgery that falls on you.
As part of this procedure, anesthesia will be given so you may sleep through surgery. A small incision will then be made at your scrotum to create access for removal of any painful testicles before untwisting of cord to restore blood flow to testicle.
Doctors use orchiopexy (pronounced orchi-oh-peck-see) to stitch the area to prevent future twisting and torsion of either testicle, and this procedure is commonly known as orchiopexy (say or-kee-oh-peck-see).
Most men suffering from testicular torsion can still preserve their testicle with timely medical intervention, so if your child experiences sudden and intense scrotal pain, have them seek medical advice immediately.
Recovery
The testicle is an essential organ that needs a steady source of blood, which is why early diagnosis and treatment for testicular torsion should be sought as soon as symptoms emerge. As pain and swelling often worsen quickly, seeking help early increases your chance of saving it altogether.
Testicular torsion occurs when one or both testicles become inaccessible because its blood supply becomes cut off by twisting of its cord carrying blood to it, forcing emergency surgery for immediate repair or loss of testicle function. Most cases occur during infancy or early adolescence but can affect people of any age.
Health care providers will conduct a physical examination of the scrotum to check for swelling and testicle position, and may use Doppler ultrasound to analyze blood flow within it and the testicle, to help ascertain if its blood supply has diminished over time. This may show whether or not its function has diminished.
In some instances, doctors can treat torsion without resorting to surgery; however, surgery is generally the better solution in order to untwist the spermatic cord and restore its normal position. If a testicle can no longer be saved it will be surgically removed (known as orchiectomy).
Torsion in one’s testicles may occur following intense exercise, an injury to the scrotum, or even during sleep. Some individuals are susceptible to torsion due to “bell clapper deformity,” a condition wherein testicles move more freely within the scrotum and therefore increase their risk.
Testicles can become inactive for more than six hours when their blood supply ceases. Therefore, it’s critical that parents regularly inspect their sons for pain or swelling in the scrotum and contact Healthdirect Australia’s NURSE-ON-CALL service on 1800 022 222 for medical advice at any time if need be. Healthdirect content is produced by Royal Children’s Hospital Melbourne and Australian Institute of Health and Welfare; while this article was reviewed and approved by one of Healthdirect’s senior nurse specialists in paediatrics before being released on Healthdirect Australia’s NURSE-ON-CALL service.
