Your body provides blood to each testicle through two long, tube-like structures known as spermatic cords that connect them with your scrotum. If these cords twist, a testicle could lose its blood supply and die – this constitutes an urgent medical issue and prompt medical assistance should be sought immediately.
Healthcare provider will use ultrasound imaging to detect testicular torsion. They may recommend surgery to unwind the spermatic cord and restore blood flow, in order to untwist and unwind it from its coiling position.
Diagnosis
Patients often present with sudden, intense unilateral testicular pain that is accompanied by the sensation of being weighted down or fullness in the scrotum, radiating into abdominal region and frequently leading to nausea and vomiting. Sometimes symptoms appear hours or even days later than anticipated and in these instances torsion diagnosis is sometimes missed.
As soon as the history and physical examination reveal torsion, physicians should initiate surgical exploration immediately – regardless of laboratory studies being available or not. There is typically only four to eight hours until permanent ischemic damage sets in. Doppler ultrasound of the scrotum or radionuclide scintigraphy are often useful methods of confirmation; otherwise manual detorsion should be attempted and blood flow restored typically within minutes if successful.
Torsed testicles often unwind themselves on their own, yet it is still wise to avoid overstretching it to prevent further testicular trauma or forearm or wrist injuries which could arise as a result.
Physicians should also be wary of other causes of pain in the scrotum, such as epididymitis, hydrocele symptoms or hematoma formation – these conditions require immediate medical intervention and will not respond to conservative measures like rest or ice packs.
If torsion is identified early enough, doctors can usually save the affected testicle through orchiopexy surgery – an operation involving placing small pieces of suture material along the spermatic cord from testicle to scrotum – which restores its blood flow and returns it back into circulation. After surgery, patients must refrain from sexual activity for some weeks afterward and should also limit strenuous activity; many boys with one testicle removed due to torsion can still father children and may eventually wear prosthetic testicles later down the road.
Symptoms
The testicles (or gonads) are two organs located beneath the penis. They produce sperm and testosterone hormone, both produced through blood from their respective spermatic cords that run down from abdomen to scrotum. When one or both cords become twisted and blocked by tight tissues such as clothing, this is known as testicular torsion and must be treated immediately to avoid permanent damage to or even loss of one testicle.
Testicular torsion affects young men and boys, often in their first year or during adolescence. Torsion usually involves either one or both testicles, with left testicles more susceptible than right ones being affected by sudden torsion; in some instances though, torsion may come on gradually over time.
Torsion symptoms for someone suffering from it include sharp, burning pain in their scrotum or groin area that worsens over time, difficulty passing urine and pain when urinating; fever, sweating or nausea could also occur as symptoms of torsion.
Health care professionals will conduct a detailed examination of both scrotum and testicles, asking about when pain started as well as its progression over time. A cremasteric reflex test can also help them assess whether torsion is to blame.
An ultrasound exam can be used to measure how much blood is flowing into a testicle, as well as show its position (such as whether it’s twisted or upright). This information can help doctors decide the most suitable treatments.
Doctors may perform manual detorsion to restore blood flow to the testicle. This involves placing the patient supine and rotating the affected testicle away from midline like opening a book; often successful and effective in alleviating symptoms associated with torsion.
Treatment
Spermatic cords supply blood to testicles (orchids) in men and those assigned male at birth (AMAB). However, in certain circumstances the cord may twist and limit or cut off blood supply to one or both testicles, potentially leading to death unless treatment begins immediately. Most physicians can save testicles that have been twisted when treated within six hours after experiencing symptoms.
Testicular torsion is an urgent urologic emergency and you should seek medical assistance immediately if you experience severe pain in either testicle, along with any unusual signs like blueish color or firmness of scrotal sac (the pouch that holds testicles), swelling in groin area or other unusual symptoms. You should call healthdirect anytime day or night and ask to speak with registered nurse (known in Australia as NURSE-ON-CALL) who can offer guidance as to what steps should be taken next.
Usually, when suffering from torsion in your groin, medical advice suggests lying down and resting while applying ice. Unfortunately, this won’t always help and could even make matters worse if the torsion has been ongoing for an extended period.
Your doctor will perform a pelvic exam, including Doppler ultrasound to check blood flow through your spermatic cord. In general, painful testicles will typically be larger and hypoechoic (lower quality), with decreased blood flow; conversely asymptomatic testicles tend to be smaller with normal or increased blood flow.
Surgery may be necessary to restore blood flow to an affected testicle. Your surgeon will typically make a small incision in your scrotum in order to expose and untwist your affected testis and unwind its spermatic cord, then fixate that testis so it cannot twist back in its place. In some cases, they may also adjust other testis if they begin twisting again later on.
Even if a torsion has been corrected quickly, the affected testicle may still shrink or die over time – this can greatly impair fertility and have long-term repercussions. If this occurs, surgical removal will need to occur, thus increasing your chance of further harm – so to reduce this possibility it’s wise to avoid strenuous exercise or sports that increase risk of testicular injury as much as possible.
Follow-up
Panel members agreed that prompt exploration is key to maintaining testicular viability; however, there was no consensus regarding an acceptable minimum delay timeframe; this depends on local circumstances, surgeon availability (i.e. if another emergency needs surgery soon) and number of operating theatres available. When viable testis are found post untwisting and fixation they should be evaluated outpatient to ascertain if their appearance has returned to normal.
Patients whose testis has not recovered its normal appearance should undergo orchiectomy and orchidopexy as there is a significant risk of infertility. Patients undergoing orchiectomy should be monitored closely for sperm count, morphology and FSH to gauge fertility; the effect of testicular torsion (TT) on fertility remains disputed, yet patients experiencing symptoms suggestive of it should see an experienced urologist to prevent loss of fertility that could potentially be devastating; greater awareness must be raised regarding TT in general practice practices as soon as possible so potential issues don’t get missed in diagnosis of treatment options
