Diagnosis
If a man experiences severe testicle pain, they should visit their physician as soon as possible. Such severe testicle pain could indicate testicular torsion which must be treated promptly to avoid permanent damage. Signs of testicular torsion include extreme pain in the scrotum, swelling or redness within it and loss of cremasteric reflex (a muscle located in the penis that activates when blood flows into testicles). Other signs include high-riding testicle and nausea or vomiting as indicators.
Hospital doctors can assess patients for torsion through physical examination. In addition, tests such as urinalysis or blood work may be ordered to rule out other conditions; additionally urologists offer surgery to untwist spermatic cords and preserve testicles.
When someone suffers a torsion, emergency surgery may be required in order to avoid permanent damage. When operating, a surgeon will administer sedation so the patient will not feel any pain during the procedure; then an urologist will cut into their scrotum to untwist the spermatic cord before attaching both testicles together in an effort to avoid future torsion issues.
Ultrasound can be an invaluable aid for emergency department physicians diagnosing testicular torsion. It allows doctors to compare a painful testicle with its asymptomatic counterpart; an enlarged and hypoechoic painful one will have decreased blood flow while an asymptomatic testicle will display normal size and color on ultrasound; color Doppler ultrasound can also confirm diagnosis by detecting blood flow patterns within an otherwise normal testicle.
Urologists may be able to untwist and fix torsion cords quickly in an emergency room setting, restoring blood flow and saving testicles. However, most individuals suffering from torsion require surgery – known as orchiopexy – in order to untwist their cords and repair any problems with torsion.
Studies suggest that for optimal torsion treatment to occur, diagnosis and de-torsion must occur within six hours of symptoms surfacing; otherwise the testicle could die without constant access to blood supply.
Treatment
Testicular torsion is an urgent medical situation requiring immediate attention. It occurs when your spermatic cord twists and cuts off blood flow to one or both of your testicles (also called testis). This causes intense pain and swelling in the scrotum; without blood in around six hours it could die and you’ll require immediate medical intervention to save it from death.
Your health care provider will conduct a physical exam of your scrotum, using imaging technologies such as ultrasound to gauge how blood is flowing within your testicles. They may also order a urine analysis to check for infection or inflammation which could potentially mimic symptoms similar to testicular torsion.
Urologists (physicians who specialize in urinary tract and male reproductive system conditions) are uniquely qualified to diagnose testicular torsion. Their diagnosis will typically based on factors like your medical history, physical exam and results of scrotal exam. Your urologist will also perform urine analysis and culture to look out for signs of bladder or urethral infection which could also contribute to testicular pain.
Most cases of torsion are diagnosed by its classic symptoms: sudden pain with sudden swelling and tenderness in the scrotal area, loss of cremasteric reflex and reduced or absent testicular blood flow. Urologists may refer less-than-classic presentations to other diagnostic testing, such as color Doppler ultrasound to assess whether blood flow is arterial or venous (which determines whether testicle has avulsed). However, most often clinical assessments such as tenderness assessments, reflex tests and position exams can accurately diagnose torsion cases (see table above).
Torsion usually requires surgery by an urologist. They will untwist the spermatic cord, restore blood flow to the testicle, secure it to prevent further twisting and secure it with stitches. Most procedures take place in hospital but in certain instances may take place through groin or rectorectum injection, in which case sedation will likely be needed; otherwise general anesthetic will likely be administered first before proceeding with orchidectomy surgery; which can be both painful and uncomfortable for the patient.
Prevention
Patients exhibiting testicular torsion should seek medical evaluation as soon as possible from a urologist for possible surgical exploration and fixation (orchiopexy). When immediate care from the urologist is not possible, manual detorsion in the emergency department (ED) can greatly increase survival rates; patients can simply be placed supine, then grasp their testicle gently at its base then turn away from midline while opening it like a book to untwist it – hopefully within minutes they should experience relief while having normalized lie of testicle normalized as well as blood flow restored on color Doppler ultrasound!
Assemble and elevate the scrotum with a rolled towel under it to elevate it and avoid sudden movements or heavy lifting. A warm bath with Epsom Salt may reduce stiffness and relax muscles, improving circulation and decreasing tension on the Spermatic Cord. Nonsteroidal Anti-Inflammatory Drugs such as Ibuprofen can help alleviate pain and swelling; any long-term testicular pain should be evaluated immediately as this may be indicative of Torsion which requires emergency attention and treatment.