Testicular torsion occurs when the spermatic cord that supports testicles in their pouch (scrotum) below the penis twists uncontrollably, and requires immediate medical treatment – most men retaining at least one testicle after surgery is conducted within six hours of symptoms being present.
This condition typically appears during the first year of life or puberty but can occur at any age. An evaluation should be scheduled with a urologist as soon as possible to help establish treatment and avoid serious health risks.
Causes
Testicular torsion occurs when the spermatic cord, which delivers blood to the testicle from its abdomen, becomes twisted within the scrotum and twists back around itself, cutting off supply to it and eventually killing the testicle. This condition must be addressed quickly to avoid permanent damage and maximize chances of having biological children (for men interested in doing so).
Urologists can diagnose testicular torsion through interviewing you about symptoms and physical examination of both scrotum and testicles, followed by ultrasound imaging of both areas and urine tests.
Testicular torsion pain may be difficult to differentiate from that caused by other conditions, including epididymitis, orchitis, scrotal hematoma or hernias. While any of these may lead to painful swelling of the scrotum or feeling full in general, pain from torsion cannot usually be alleviated by raising up its affected testicle, nor typically result in cremasteric reflex.
Avoid testicular torsion by keeping it from twisting in the first place. This means not putting too much strain or pulling too hard when donning pants and shirts, wearing loose-fitting clothing and wearing an athletic cup that fits properly to protect your testicles when participating in sports activities.
Treatment for testicular torsion should be administered as soon as possible because if left untreated it can result in lasting damage lasting six hours or more and death of the testicle (“infarct”). Emergency room physicians can often untwist and save twisted testicle, while for some individuals an orchidectomy must take place to stop further twisting from happening again.
Rarely, both testicles twist at once; however, it does occur occasionally. Most often it affects only one testicle — particularly the left one — and tends to occur more often among younger men or newborn babies. Genetic traits play a part in how easy your testicles rotate in your scrotum; having one that twists easily could run in your family.
Symptoms
Rotating testicular can twisting can twisting can twisting can twist spermatic cord that delivers blood to scrotum (loose bag of skin under penis that contains testicles) which in turn restricts its flow and causes sudden pain and swelling. Testicular torsion should be considered an urgent urologic emergency and treated quickly in order to reduce complications and risk.
Patients experiencing severe, unilateral scrotal pain should undergo Doppler ultrasound of their testicle to examine its presence and degree of blood flow. A normal testicle will have bright red color with clear blood flow; torsed testicles typically have paler hues with limited circulation; occasionally blue dots may also be present due to torsed epididymis or testicular appendages that tether it down.
Testicular torsion symptoms typically include pain that increases in intensity or frequency, and may include a tugging sensation in the groin area. Although testicle torsion usually affects only one testicle at once, rare instances may involve both testicles being affected by torsion.
If the torsion is caught early enough, it is often possible to rescue the testicle and prevent further torsion or fertility loss. If left undetected and treatment delayed too long however, permanent damage could result.
Patients who have had testicular trauma should always be evaluated for torsion, even if the injury was mild. This is particularly relevant if their testicle has not returned to its usual size 1-2 hours postinjury. Although ultrasound can provide useful data in diagnosing torsion, most often clinical evaluation is sufficient.
Before performing an ultrasound examination, consult with a urologist first. If it appears that torsion has taken place, an orchiopexy procedure known as orchiopexy should be undertaken as soon as possible to secure the unaffected testicle to the inner wall of the scrotum and ensure it does not twist again in future; best results can be achieved if this surgery occurs within six hours after initial symptoms arise.
Diagnosis
Testicular torsion can only be diagnosed clinically; typically patients show sudden-onset testicular pain. Early evaluation by a urologist should take place, with ultrasound using color flow technology being particularly beneficial in demonstrating arterial blood flow – an essential finding that differentiates this condition from others such as epididymitis or inguinal hernia.
Torsion occurs when the spermatic cord twists inside of the scrotum and cuts off blood flow to the testis, causing irreparable damage and leading to rapid viability loss of a testicle. Testicular torsion should be considered an emergency situation that requires surgery as soon as symptoms appear – typically within six hours is ideal in order to save it!
Young boys suffering from testicular torsion typically wake up either late at night or very early in the morning with excruciating scrotum pain, prompting them to seek immediate medical assistance as an untreated testicular torsion may result in permanent damage to their scrotums. It’s vital they seek medical advice immediately because untreated torsion may lead to lasting harm – further damaging their body as a whole.
Rare disease that strikes approximately one out of every 4,000 men under 25. Additionally, newborns and older adults can also be susceptible. Most commonly it affects a single testicle on one side – more often on the left side.
An interprofessional team must respond immediately. A diagnosis can be established through an extensive history and physical exam as well as using Doppler ultrasound with color flow (see image below). Doppler displays normal arterial and venous blood flows in the scrotal sac – arterial flows appear as spikes on Doppler waveform, while venous flow appears as plateaus – to provide accurate timeframe information regarding when symptoms began arising and can also help distinguish this condition from epididymitis, inguinal hernia or even scrotal hematoma which may all potentially serious causes of issues in terms of timeframe.
Treatment
Your body provides your testicles with blood through long, thin cords called spermatic cords that transport it from your abdomen to your scrotum (a loose pouch of skin beneath your penis that holds them). If one testicle rotates and twists its cord, this can cut off blood circulation to one side of your scrotum and result in severe pain and swelling; therefore it must be addressed within six hours to avoid permanent damage to this organ. Testicular torsion should always be considered medical emergency.
Your physician will ask about your symptoms. Be prepared to describe sudden, sharp pain as well as associated signs and symptoms such as nausea or vomiting. This condition often arises during puberty; however, it can affect people of all ages.
Testicular torsion can be extremely uncomfortable and often hard to pinpoint which testicle has been affected. Most often felt on the left side, its pain may occur while sleeping, awake, sitting or active – this condition should never be considered normal part of growth and development and treatment should be sought immediately.
Primary symptoms include sudden, intense testicle pain while awake, sleeping or moving. You may also notice redness or lumpiness in the scrotum as well as one testicle feeling smaller or higher than its partner.
An ultrasound of the scrotum is an effective way for urologists to diagnose testicular torsion. Your doctor will check for signs of damage in addition to Doppler waveform analysis that indicates arterial or venous blood flow – arterial flow will show as large spikes on Doppler ultrasound waveforms.
If your torsion is severe, surgery to unwind and secure the cord to the inner wall of your scrotum may be required to resolve it. In most instances, outpatient surgeries are performed as well as procedures to connect both testicles to their respective testicles and prevent future twisting.
