Each testicle hangs from a pouch of skin known as the scrotum and receives blood through a spermatic cord that runs from its source in the abdomen all the way down into its home in its scrotum.
Urgent surgery to untwist and restore blood flow is required if testicles are to be saved. The sooner this procedure can take place, the higher its success rates may be.
Manual detorsion
Manual detorsion is a bedside maneuver which involves manually untwisting and rotating the testicle from medial to lateral in order to restore blood flow to the testis and relieve pain. Emergency physicians familiar with manual detorsion often perform it for rapid pain relief; its success has not delayed further exploration or surgical repair (orchiopexy); however it should not be used as a replacement for immediate surgical treatment in cases requiring immediate surgical repair (orchiopexy).
The testicles are two paired oval-shaped structures that develop prior to birth and slide from inside the body into a pouch-like structure called the scrotum for development during puberty. They serve as sources of sperm production and release hormones which promote sexual maturation. A twisting or tearing of the spermatic cord, which connects each testis directly with its blood supply via blood vessels, nerves, and ducts, results in severe pain at scrotal level as well as testicular torsion which cuts off blood supply completely; potentially leading to its death.
If a testicle has not been twisted, it may recover on its own if its blood supply returns within six hours after pain begins. However, if its blood supply has been interrupted for more than eight hours it becomes anatomically vulnerable to re-twisting and requires emergency treatment immediately.
Recent research demonstrated the use of a portable, handheld ultrasound device with real-time color Doppler guidance during manual detorsion can enhance pain relief and restore normal vascular flow to the testis. Emergency physicians utilize the device, and it requires no additional training beyond residency to use correctly and to completion; instant visualization of restorative blood flow allows the physician to confirm detorsion is complete.
Study authors suggest that emergency manual detorsion should be attempted on all patients who present to an emergency department with symptoms of testicular torsion. Based on results of this research study, about 80% of pediatric cases can successfully complete detorsion under manual guidance; its success rates decrease with older children and adults; presence of scrotal edema increases failure rate but should not disqualify from trying the maneuver.
Ultrasound
Testicular torsion is a medical emergency that can result in excruciating discomfort in the groin area. This condition occurs due to twisting of the spermatic cord, cutting off blood flow to an affected testicle. Signs and symptoms include red, swollen scrotums, acute testicle pain and nausea or vomiting – it is critical that immediate treatment be sought immediately as delay could lead to permanent damage and should therefore not be ignored.
Ultrasound imaging is the preferred method for diagnosing testicular torsion. The transducer, which emits sound waves into a computer system and creates an image of your scrotum and testicles, allows doctors to quickly examine blood flow to individual testicles to see if any are twisting; additionally color flow doppler ultrasound can compare healthy testicles against affected ones for accurate comparison purposes.
Ultrasound remains the gold standard diagnostic test; however, its interpretation can sometimes be challenging. Painful or swollen appearance of the scrotum could indicate epididymitis or strangulated inguinal hernia; to avoid time and resource waste it is crucial that when this condition presents itself that immediate consultation with a urologist takes place.
Urologists conduct physical exams of the scrotum and testicles. They will inquire into any history of symptoms as well as look for any indications of trauma to determine the source of any issues, which could include ordering tests such as urine samples, urinalysis tests and ultrasound imaging of the scrotum.
Urologists will recommend surgery as soon as possible to avoid irreparable testicle damage, usually within 12 hours of symptoms appearing; otherwise, irreparable damage could occur and death result in irreparable sterility. Furthermore, orchiopexy will help prevent recurrences; while sometimes saving marginally viable testicles is suggested but this could result in infertility due to breached blood-testis barriers.
Radionuclide testicular scintigraphy
Testicular torsion can affect anyone, regardless of gender. Early recognition and treatment is critical in order to avoid ischemic injury to one of the testicles and even its loss. A telltale sign of torsion is pain in one testicle at any time during wakefulness, sleepiness, standing or sitting – pain that occurs regardless of time of day, nightfall or sitting position – swelling in scrotum as well as red or dark coloration on one of them may also indicate torsion.
Patients who have been exposed to testicular trauma, varicocele or inguinal hernia are at an increased risk for testicular torsion. A comprehensive workup should include Doppler ultrasound evaluation as well as radionuclide scintigraphy for an acute testicular torsion diagnosis in order to differentiate it from epididymitis.
Radionuclide scrotal studies using sodium pertechnetate Tc99m can reliably differentiate testicular torsion from epididymitis in most adult males, though neonates and small children are less reliable due to smaller blood vessels within their testicles. To assess the sensitivity and specificity of radionuclide testicular scintigraphy in detecting torsion among anesthetized animals in this population, we evaluated static and angiographic images from 17 anesthetized animals before, 2 hours after, and 20 hours post ligation of one testicle. Ligation resulted in significantly decreased accumulation of radionuclide accumulation within the scrotal region while simultaneously showing an increase in extracellular fluid (ECF) space.
Radionuclide scrotal scintigraphy is an easy and fast diagnostic procedure used by emergency physicians to differentiate acute testicular torsion from epididymitis or other causes of scrotal pain in children and adults alike. When combined with other diagnostic tools like Doppler ultrasonography or urological consultation, this approach can speed diagnosis and treatment by prompting manual detorsion to restore testicular flow before further surgical exploration and orchiopexy on affected testis; additionally it reduces unnecessary invasive procedures that would otherwise need be undertaken on affected testis.
Urinalysis
Urinalysis is a laboratory test that analyzes the composition and properties of urine. It’s commonly used to screen, diagnose and monitor various health conditions; in particular kidney or liver diseases which don’t yet show symptoms such as chronic urinary tract infections or prostate problems. Urinalysis tests can be run on children, adults and pregnant women alike.
Urinalysis tests include various assessments. These may include visual examination, microscopic evaluation and chemical dipstick tests that measure various aspects of urine including clarity/turbidity/color and any presence or absence of abnormalities such as blood. They can also examine concentrations of urea particles (creatinine, blood, bilirubin and protein), concentration levels as well as potential bacteria such as E. coli.
Healthcare professionals usually administer these tests. Before beginning, they may ask patients to empty their bladder into a container before beginning; or the physician may use a catheter or thin tube to take samples from their urethra directly and place them into a clean, sterile container for analysis.
Prior to beginning their urinalysis test, healthcare providers will use germ-killing solutions to clean around the opening of your urethra and insert a catheter to drain urine into a sterile container for analysis at a lab.
Urinalysis can be an invaluable asset when diagnosing testicular torsion and other urological problems. This non-invasive test provides essential insight into the condition of one’s urinary system. Abnormal results don’t always indicate there’s something more serious amiss; nonetheless it’s essential that further testing and treatment if required are pursued immediately.
Patients undergoing urinalysis should wait to be instructed by their healthcare provider before taking medications or supplements, since many over-the-counter and prescription drugs can interfere with its accuracy. Also be sure to inform them about any dietary or herbal supplements being consumed, just in case these may affect results of the test.
