Torsion of the testicular cord is a surgical emergency requiring immediate diagnosis and treatment, as it causes intense unilateral scrotal pain that requires immediate recognition and intervention.
Torsion in testis may have an adverse impact on its contralateral testis due to ischemia-reperfusion injury, the formation of antisperm antibodies (ASA), and changes in scrotal physiology, potentially impacting concentration, motility and LH levels in men with torsion.
Symptoms
Testicular torsion is a potentially life-threatening medical emergency caused when spermatic cord that holds testicles in place in the scrotum becomes twisted, cutting off blood supply to one or both testicles. Treatment should begin immediately as blood flow must be restored within six hours otherwise testicles will die and men with torsion may experience pain, swelling, lumps in their scrotums as well as sudden sharp pain radiating to abdomen preventing them from sleeping comfortably or lying down easily.
Time of onset of symptoms is the single most influential factor when it comes to saving a testicle, and testicular viability decreases quickly within six hours after showing any symptoms; so it is imperative that any individual seeking evaluation by a urologist seek an evaluation appointment immediately.
Testicular torsion can be diagnosed through history and physical exam, where patients typically report sudden, severe, unilateral testicular pain accompanied by nausea and vomiting that is worse at night. Elevation may provide temporary relief; however, Prehn’s sign (stroking the opposite thigh causes reflex elevation of head of testis upon stroking it) should not be trusted when diagnosing testicular torsion; rather, an alternate cause such as testicular acromegaly (in which one or both tubes drain testicles from scrotum become enlarged) or even an inguinal hernia could be contributing to its severity.
Scrotal ultrasounds can help diagnose testicular torsion. While abdominal and pelvic ultrasounds can often be done anywhere, scrotal ultrasounds must only be conducted at hospital urology laboratories and need to be performed by trained urologists; experienced medical assistants may also perform it if possible. A scrotal ultrasound can detect tumors, hydrocele, hernias or any conditions requiring treatment; additionally, urine analysis results are often unhelpful when diagnosing testicular torsion; results alone may not indicate whether torsion can be saved or not.
Diagnosis
Testicular torsion occurs when your spermatic cord, which supplies blood to your testicles, twists and cuts off its blood supply to one or both testicles. It’s an emergency situation and should be treated quickly or you could risk losing one of them altogether.
Newborns and young children experience different symptoms than adults do; although they may not feel any pain, their scrotum might turn red or hard, with an affected testicle lying abnormally (high-riding). Vomiting might occur; parents might recognize this during a diaper change or newborn exam. Torsion can also occur among older children and adults when engaging in vigorous physical activities such as sports.
Doctors typically evaluate scrotal pain through physical examination. They look out for tenderness and swelling as well as signs of cremasteric reflex (a muscle that opens your testicle when you flex or bend at the waist), Doppler ultrasound testing can also be used to measure blood flow within the testes.
If your doctor suspects you of having testicular torsion, they may suggest having scrotal exploration surgery under general anesthetic. This procedure involves making an incision (cut) in your groin to access the testicle and untwist it manually by an experienced surgeon.
Once released from hospital, you should keep a close watch on your scrotum for signs of further pain or other problems. If you’re concerned about testicular torsion in the future, speak to your physician; they may suggest wearing loose-fitting underwear or engaging in exercises designed to allow freer testicular movement.
Rarely, your doctor might discover that you don’t actually need surgery after all and simply require stitches – this happens about one in 10 times when having testicular torsion surgery performed. In such a scenario, one testicle could possibly need stitching into place so as not to twist later. If two testicles have torsion present simultaneously, stitches might also need to be used on one in order to keep both from twisting further later on.
Treatment
Your testicles receive blood from the rest of your body through long, thin tube-like structures called spermatic cords that connect from your abdomen down into your scrotum and inside each testicle. If a twisted or kinked spermatic cord prevents sufficient blood flow into a testicle, its size could shrink and die within six hours without treatment – so beware any symptoms of testicular torsion that arise – promptly seek medical advice if it occurs as these could potentially require emergency medical intervention!
If you are experiencing severe pain in your scrotum and suspect testicular torsion, seeking medical care immediately is crucial. Healthcare providers will assess your condition through taking a detailed history and performing physical exams on both testicles and scrotum as well as performing ultrasound imaging and possibly referring you to a urologist (an expert who treats urinary tract and reproductive problems).
As a rule, one symptom of testicular torsion is sudden and intense pain in one testicle. The pain may be present while you’re awake or sleeping; lying down may intensify it further or it might occur standing, sitting, or active – typically, the pain will remain sharp for hours at a time before finally subsiding on its own. Other scrotal symptoms you might notice are swelling of either your scrotum or one testicle.
While waiting for help, you can do several things to ease the pain and speed up recovery. Wrap ice cubes or commercial cold packs in cloth and apply it directly to your scrotum for 10-15 minutes at a time; nonsteroidal anti-inflammatory drugs like ibuprofen may help ease inflammation; you could also try lying back with knees slightly bent to reduce tension on spermatic cord.
If diagnosed with torsion, your urologist will likely perform emergency surgery known as orchiopexy to untwist and restore blood flow to the testicle. Depending on its severity, orchiopexy may take place either at home or hospital operating room settings using special tools called scrotal clamps to release the twisted spermatic cord and restore normal flow of sperm; or an orchiectomy whereby obstructed testicles are surgically removed from your body by removal;
