Each testicle rests inside its own pouch known as the scrotum and receives blood from an extension called a spermatic cord that runs upward from each testicle and into the abdomen.
If a patient exhibits sudden pain, swelling in their testicle, and loss of cremasteric reflex, torsion should be presumed until proven otherwise. A urologist can often untwist it via emergency surgery to restore blood flow and minimize lasting damage.
Symptoms
The two testicles (known as testes) sit within a pouch called the scrotum below the penis and produce male sex hormones and produce sperm, which is carried from each testicle through its associated spermatic cord to be released into the urethra via the spermatic canal. Under normal circumstances, this cord keeps both testicles in their proper positions to prevent twisting; however in certain men with bell clapper deformity or lacking connecting tissue may allow the testicles to move freely within their scrotum and twist freely inside their own scrotums.
Testicular torsion often presents with sudden, intense pain in one testicle. This discomfort can arise while sleeping, awake or active; and may feel similar to “sharp, burning snapping pain”. Furthermore, this discomfort might be more intense on one side of the affected testicle which sits higher in the scrotum.
An emergency room doctor can diagnose testicular torsion by asking pertinent questions and conducting a physical exam of both the scrotum and testicles. He/she might gently rub or press on affected testicles in order to cause cremasteric reflex; when touched this reflex usually produces contraction of testicles. Torsion could prevent this reflex from taking place – something an emergency room doctor cannot always detect with mere physical exam findings alone.
Torsion may also be indicated by an epididymis that becomes tender and swollen over time, although it can be difficult to tell apart this symptom from gradual pain and swelling compared to sudden, widespread symptoms associated with torsion.
Doctors performing surgery to untwist your son’s testicle will use painkillers and general anesthesia so he is pain-free during surgery, then make a small cut in his scrotum and insert a laparoscope (a thin tube with a camera on its tip) using tools to separate spermatic cord from testicle, then return testicle back into its usual position before stitching up his scrotum.
Whenever a testicle can no longer be saved, doctors perform an orchiectomy procedure to remove it. Most boys who undergo orchiectomy will still be able to have children later on; however, certain activities might need to be avoided until cleared by their physician before returning to them. Some boys opt for prosthetic or artificial testicle replacement instead.
Diagnosis
Testicular torsion is an acute medical emergency characterized by sudden severe pain and swelling of one testicle. This occurs when the spermatic cord twists around, cutting off blood flow to the testis. If left untreated quickly, testicular torsion could result in permanent loss of testicular function – one of the most prevalent urological emergencies among boys and young men aged 25 or under, with annual incidence rates as high as one out of every 4,000 males younger than 25 years.
Symptoms of testicular torsion include sudden, severe local pain, nausea, vomiting and scrotal edema. Affected testicle may be raised or horizontal; cremasteric reflex is usually absent; diagnosis is made based on history and physical exam, then confirmed via ultrasound (US) using color Doppler flow with probe placed against skin of scrotum and affected testis; analgesics and antianxiety medication are used to manage pain as well as stay still and allow an US probe probe to complete diagnosis; such medications help relax patients enough for testing to take place.
Due to the risk of misdiagnosis, if you or your son exhibit symptoms of testicular torsion it is vital that they visit a physician as soon as possible. A physician will conduct an exam of their scrotum, testicles and abdomen before asking questions and testing cremasteric reflex – this involves lightly pinching or rubbing inside of their thigh on affected side until testicle contracts – however this might not happen with those suffering from torsion.
Urethral or penis torsion may produce similar symptoms to testicular torsion, so it’s essential that your physician rule them out as potential sources. Urologists should typically be consulted early in the workup for torsion. A scoring system was devised that helps doctors identify patients who have a high probability of torsion thus decreasing diagnostic testing requirements (see Workup).
If the spermatic cord becomes completely twisted, blood will no longer pass through the testicle and surgery may be required to restore blood flow. Sometimes doctors can manually detorsion (manual detorsion). Other times however, surgery will need to be performed whereby they surgically cut and stitch together testis and scrotum under general anesthesia; some patients may bleed slightly from incision sites for several days post surgery which is normal and expected.
Treatment
An active-duty boy suspected of testicular torsion should seek emergency medical assistance immediately. He should detail his pain level and whether it’s associated with nausea and vomiting, before consulting a urologist who should examine him for signs of torsion such as an inflamed or twisted testicle and swollen scrotum; doppler ultrasound may also help determine blood flow – though often an twisted testicle won’t show it on this measurement!
As soon as a boy develops a torsion, surgery should be immediately pursued; otherwise his testicle could die from lack of blood flow and be lost forever.
Doctors typically diagnose ovarian torsion by reviewing a patient’s symptoms and conducting a physical exam, including asking about hormone medications which induce ovulation such as birth control pills or infertility treatments that utilize ovulation-stimulating hormones – these increase risk of torsion.
At surgery, doctors will make a small cut in the scrotum and untwist the spermatic cord before stitching testicles to the inside of the scrotum to prevent future torsion. Following surgery, any wound may ooze for one to two days after which boys should remain sedentary in order to support recovery and wait until their doctor gives them clearance to engage in sexual activity.
Ovarian torsion is a life-threatening condition requiring immediate medical intervention. Without surgical treatment, both an ovary and fallopian tube could cease functioning altogether and could even die due to lack of blood flow.
Tests used to diagnose ovarian torsion include ultrasound of the abdomen and pelvic examination, in addition to ordering a blood test to check for red blood cells and electrolytes in your system.
As part of ongoing trials to assess oxidative stress reduction during and after torsion events, various medications have been examined for their ability to decrease oxidative stress levels. While results varied across trials, certain agents showed promising effects in terms of mitigating damage caused by torsion events and restoring function post detorsion – these agents include antioxidants, anti-inflammatory and ROS scavenging agents.
Prevention
Testicular torsion risk decreases over time after initial symptoms appear, so early diagnosis and treatment are crucial. Anytime someone experiences severe pain in the scrotum it should be reported immediately to their physician regardless of age or history of testicular issues.
Surgery is often used as the go-to solution to treat testicular torsion, known as orchiopexy, to secure testicles to the inner surfaces of the scrotum and stop their rotation. If a torsion has already taken place or high risk individuals have experienced symptoms for 6 hours after symptoms began presenting themselves; surgery must take place promptly otherwise viability of testicles quickly diminishes dramatically and it’s best done sooner rather than later.
Sometimes a surgeon can manually untwist a testicle without needing to go into surgery. With the patient lying supine, their physician grasps and rotates it away from midline as though opening a book – this usually works successfully and restores blood flow quickly; though in rare instances more than one attempt may be needed.
If an ovarian torsion goes undetected and untreated immediately, its blood flow could reduce to such an extent that it will eventually die – in which case your doctor will remove both it and any related tissue as necessary – however even though one ovary has necrosised, conception and pregnancy remain possible.
Encourage your son to seek medical attention as soon as they experience sudden, severe scrotal pain – the best way to decrease his chance of losing a testicle! Even if one does become lost, surgery may still be performed to secure and ensure the other one doesn’t twist inward, with most boys experiencing an orchiectomy eventually going on to be fathers later in life.
