Testicular Torsion occurs when the spermatic cord twists and cuts off blood flow to one or both testicles, creating an emergency medical situation and necessitating immediate treatment. Any damaged (infarcted) testicles may need to be surgically removed in order to preserve men’s ability to father children.
Ultrasound imaging can help determine and treat testicular conditions within six hours, helping doctors make accurate diagnoses and determine severity.
Symptoms
Testicular Torsion occurs when the spermatic cord that holds testicles in place in the scrotum twists, cutting off blood flow to them. It is an emergency medical situation and must be treated immediately in order to avoid permanent damage or loss of testicles. Most often seen among prepubescent boys starting puberty but it can happen at any age due to trauma, heavy exercise or sudden swelling of testicles. It usually affects prepubescent boys between prepubescence and puberty but it could happen at any age as it cuts off blood supply which to testicles themselves. Torsion causes cut off blood flow causing permanent damage or loss affecting testicles themselves, leaving permanent damage or loss of testicles causing serious permanent damage that must be managed immediately to preserve testicles themselves. Torsion typically affects prepubescent boys at or just after puberty as an emergency situation unfolds wherein permanent damage or loss may result. Torsion most commonly affects prepubescent boys or adolescents at or shortly before puberty begins; however it can occur at any age due to any incident such as blow to scrotum, exercise, sudden swelling of testicles resulting in permanent damage or loss.
The most frequent sign is severe one-sided pain that arises quickly. The intensity may fluctuate throughout the day or be intermittent; when touched directly it may cause tenderness. You might also have a discolored, distended, or misshapen testicle as part of this condition.
Many symptoms associated with testicular torsion include nausea or vomiting and fever. Doctors can diagnose testicular torsion based on these symptoms as well as health history information and perform a physical exam and order an ultrasound scan to view both scrotum and testicles – it will even indicate whether or not your spermatic cord has become torsed.
Healthcare providers who are familiar with torsion will likely refer their patient to a urologist (a specialist who treats conditions relating to urinary tracts and reproductive organs). A urologist can diagnose torsion through conducting a full exam of the scrotum, including inspecting testicles; also providing medical history details and taking temperatures.
Signs that the scrotum is twisting include sudden pain, loss of cremasteric reflex (stroking the thigh causes testicle to rise), and no or equivocal ejaculate. A scrotal ultrasound with color Doppler can accurately diagnose torsion by showing reduced or absent blood flow to an affected testicle – this is considered the gold standard in diagnosing it. Other symptoms to look out for include high-riding testicle and redness on scrotum; taking Ibuprofen according to dosing instructions can also help ease pain and inflammation.
Diagnosis
Testicular torsion can be diagnosed using a combination of history, physical exam and scrotal ultrasound. History should include sudden and severe unilateral testicular pain that does not improve with positioning or lying down; patients may also report nausea and vomiting. Scrotums often become enlarged with one testis higher up than another within it; additionally, ultrasound scans may reveal visible spermatic cord twisting relative to an unaffected side; additionally ultrasounds can confirm that this testis is no longer receiving blood flow.
Torsion requires a high index of suspicion, even when ultrasound is unavailable immediately. If a patient presents with low suspicion, however, a simple history and physical exam should be conducted in order to rule out alternative conditions like hernias that can produce similar symptoms of scrotal pain.
Cremasteric Reflex (CR): One reliable clinical indicator of testicular torsion is triggered when touching an ipsilateral thigh and touching it causes the patient to raise the affected testicle. If there is no sign of this reflex when touching either leg, patients should be evaluated immediately by a urologist for surgical management.
Urologists will perform surgery to untwist the spermatic cord and restore blood flow to the testicle, before performing orchiopexy to repair any damage and close off orchiopexy (if caught early enough, the testicle may still be saved), but lasting damage usually begins after six hours without blood flow.
Numerous efforts have been undertaken to decrease ischemic time and enhance outcomes of testicular torsion. Many hospital systems have developed quality improvement pathways to ensure prompt assessment and treatment of torsion; it is imperative that healthcare providers are familiar with these protocols as delays in intervention may significantly increase the chance of losing salvageable testicles.
Treatment
Blood flows to each testicle through two spermatic cords – long, thin tubular structures running from the abdomen down into the scrotum – that connect to two testicles. Under normal circumstances these cords are secured to tissue in the scrotum with sutures; if a testicle rotates while hanging freely it can twist a cord and cut off blood flow completely; without sufficient oxygen supply this could eventually lead to shrinkage and death of that testicle; physicians can usually restore blood supply within six hours after initial symptoms appear by restoring blood flow from both ends within six hours of starting symptoms appearing.
An acute testicular pain should be considered a medical emergency and evaluated promptly, even if the affected testicle does not appear twisted. Urology services must be contacted as soon as possible for assessment and referral of such cases.
Ultrasound is often the preferred diagnostic method in emergency departments when diagnosing suspected testicular torsion. An ultrasound will demonstrate reduced blood flow to the affected side, and could show evidence of torsion such as a twisted spermatic cord on imaging.
Surgery offers an opportunity for detorsion of affected testicles and reconnection of spermatic cord. Furthermore, surgeons often tack another testicle onto the scrotum so it cannot rotate; this step is vital as twisting of testicular tissues may increase and make detorsion more challenging.
Recent advocacy calls for the use of pharmaceutical agents to alleviate oxidative stress and ischemic damage associated with torsion torsion (TT). Studies have investigated ibuprofen, melatonin, N-acetylcysteine and oxytocin as treatments; though trial results vary across trials they all showed some evidence that these pharmacologic agents decreased oxidative changes caused by torsion.
Testicular torsion, though rare, may occur if one or both testicles rotate in the scrotum. A urologist should be consulted early on in order to evaluate risk and recommend strategies to lower potential for testicular torsion events. In cases where removal of one testicle as part of treatment for torsion is necessary, a prosthetic replacement can be fitted after growth into adulthood has taken place.
Recovery
Testicular torsion is a potentially life-threatening condition. It most frequently affects young boys and men between 12-18, but may happen after exercise, sleeping on one’s back, an injury to either testicle, or from trauma to either of the testicles. When this happens it’s vital for anyone affected to visit a hospital as soon as possible as surgery might be necessary and quicker treatment could save their testicles by cutting off blood flow to them before it has twisted too far and cannot be saved anymore.
An orchiopexy (pronounced OR-kee-oh-peese) surgery can be performed to address this problem, though often done as an emergency. Your doctor may use ultrasound imaging or other forms of testing to monitor blood circulation to your testicle to see if saving it might be possible.
Once their surgery is over, children should wear loose clothing and scrotum-friendly underwear to protect the surgical incision site. Furthermore, exhausting activities and sexual activity (if applicable) should be avoided until given permission by their physician. Analgesic and antianxiety medication might be prescribed to ease pain while antiemetics could help combat nausea.
