Doctors sometimes cannot save a testicle that has become twisted, in which case an orchiopexy or orchiectomy procedure will be needed to remove it. Most boys who undergo orchiectomy can still father children later on, while they can even get a prosthetic testicle implanted if desired.
If a patient exhibits classic symptoms of torsion, such as sudden pain and diffuse swelling, no other testing may be required. However, ultrasound can provide valuable diagnostic insights if their symptoms fall outside this category.
What is testicular torsion?
Testicular torsion is a medical emergency that necessitates surgery immediately to relieve pain and swelling and avoid the loss of one or both testicles. When treated within four hours after symptoms appear, about 90% do not require their testicle removal; but after four hours have passed after symptoms appear, chances of saving it diminish significantly and you only stand a 60% chance.
Testicular torsion occurs when blood flow to one of your testicles is interrupted or severely reduced, typically by twists in your spermatic cord running from abdomen to scrotum carrying sperm from each testicle to penis, becoming blocked in one direction or the other. A testicular torsion typically presents itself with sudden, intense pain in one testicle – either when sleeping, awake, sitting down, active or resting; its intensity may grow over hours or days as symptoms worsen over time.
The testicles are two organs located within a pouch called the scrotum, located below the penis. The scrotum houses organs such as the vas deferens and spermatic cord that carry sperm from both testicles into your urethra; these structures produce male sexual hormones like testosterone. Torsion occurs when this cord twists inside your scrotum – commonly occurring among 12- to 18-year-old boys and men.
Most testicular torsion causes are unknown; however, genetic conditions known as bell clapper deformity could increase your likelihood of testicular torsion by making testicles more mobile in your scrotum and thus increase risk for torsion.
Your health care provider will carefully examine both your scrotum and testicles. He or she may use medical imaging techniques such as ultrasound to monitor for blood flow and whether any testicle remains alive. If a torsed testicle needs untwisting, our urologists (urinary tract and male reproductive system specialists) offer orchiopexy as a special procedure that will unwind it back out, restoring blood flow and increasing its effectiveness.
Symptoms of testicular torsion
Testicular torsion symptoms typically include sudden, intense pain in either one testicle, typically on its left side and worse on that side; often leading to vomiting or nausea and worsening over hours or days; sometimes leading to swelling; occasionally people may also notice that one or both testicles feel heavier than usual and appear dark or red in color – additional indicators.
Testicular torsion typically affects teenage males, though it can occur at any age. It is more prevalent during exercise or after an injury to the scrotum; or congenital conditions called bell clapper deformity which allows more free movement of testicles in the scrotum and increases chances of twisting the spermatic cord.
If a person shows symptoms of testicular torsion, he should visit an emergency department immediately. Otherwise, his testicle could become permanently damaged or even die without intervention within six hours and require permanent repairs or even removal.
Healthcare providers will initially gather the patient’s symptoms and medical history before performing a physical examination of their scrotum and testicles, including checking blood flow to affected testicles against those of non-affected testicles, as well as performing ultrasound to check whether spermatic cord twisting occurs.
People experiencing testicular pain will typically require hospital surgery as soon as possible in order to restore blood flow to the affected testicle and prevent permanent damage. As part of surgery, your physician will also remove any appendix testis (an innocuous piece of tissue on top of your testis that serves no function) that might be present.
After surgery, patients may require pain medication for several days postoperatively to control pain. He should refrain from physical activity that increases swelling and may feel some discomfort; but should return to normal within approximately a month. In order to help their scrotum heal more quickly after surgery, patients should wear loose underwear such as boxers instead of tight-fitting pants or briefs.
Diagnosis of testicular torsion
Torsion of a testicle is an urgent medical situation requiring immediate attention, as its symptoms include sudden and severe pain in the scrotum or feeling that your testicle is being torn from its socket. Without diagnosis and treatment, death of the affected testicle could occur within 6 hours. When detected early enough and left undiagnosed and untreated it can occur quickly resulting in permanent damage or loss. Torsion symptoms include sudden severe pain in scrotum as well as feeling as if one’s testicle being pulled out from its socket; symptoms that should prompt prompt action include sudden severe pain felt on being touched on testicular torsion include sudden severe pain with sensation that your testicle being pulled away from its socket being pulled by being pulled apart by force being pulled out.
This pain may appear suddenly or gradually over hours or days. It may occur on one teste more than the other or affect both testes; more likely to strike young men due to trauma or exertion than adults; it can also be the result of congenital conditions known as bell clapper deformity, which makes it easier for the spermatic cord to twist.
Doctors can diagnose testicular torsion by gathering information about symptoms and health history from their patient, performing a physical exam, and ordering an ultrasound of their scrotum and testicles to check blood flow. Emergency department doctors frequently utilize ultrasound because it allows doctors to compare asymptomatic testicles to those suffering pain as well as detect lack of blood flow (an indicator of torsion), thicker skin on affected sides, or in rare cases even small hydroceles that occur on non-affected sides – which are all markers for torsion diagnosis.
Laboratory tests cannot accurately diagnose torsion due to their limited sensitivity and specificity. If there is even the slightest suspicion of torsion, surgical exploration should be immediately undertaken rather than waiting for laboratory studies’ results – surgical exploration will provide definitive solutions and can prevent complications, including testicular infarction.
In an operating room setting, an incision will be made in the scrotum to expose and untwist the affected testicle, then examined for color and viability. If alive, orchiopexy (fixation to inner lining of scrotum to prevent retorsion). If viable but no longer functional then removal will occur with both testicle fixed in place to help prevent further retorsion; dissolvable stitches will then close any cuts made in scrotum post surgery to facilitate healing process – walking regularly will increase blood flow to aid recovery process by increasing blood supply to its interior; helping speed healing further than just surgery alone.
Treatment of testicular torsion
Testicular torsion is a medical emergency. Without prompt intervention and deconvolution of the torsion, blood flow to the testicle will cease and kill it. While detwisting may be difficult and require careful manipulation, doctors are usually successful in saving most testicles if treatment begins within six hours after first showing symptoms.
Physical examination is the initial step. Your doctor will check your scrotum and testicles for swelling, redness, lumps or any indications that blood flow has become compromised. Doppler ultrasound can aid with diagnosis as well as showing any potential problems with circulation.
Testicles may twist due to how they hang in the scrotum; in certain people it hangs looser, allowing it to move more easily than for others. A testicle could twist during vigorous exercise or when emerging into cold temperatures after awakening in bed at night.
Testicular torsion may also be the result of birth defects that are common among men. Some individuals are born without tissue that connects their testicles to their scrotum, leading to bell clapper deformity; in these men, testicles hang loose within the scrotum and rotate more freely than normal, potentially leading to testicular torsion.
Once a torsion has been diagnosed, medical intervention must take place immediately. A surgeon may untwist and restore blood flow to the testicle immediately – the chance of success depending on both how long ago the initial torsion began and its degree.
In some instances, doctors may not be able to untwist spermatic cords due to tight scrotums; in these situations, orchiopexy can help attach testicles securely within scrotums to prevent future torsion and ensure future safety for adolescents and adults alike. It should also be noted that those who have had testicular torsion in the past are at a greater risk for repeat incidents in future years.
