Men experiencing sudden, intense pain in one testicle should seek medical assistance immediately as this could be a telltale sign of torsion, where your testicle twists around itself cutting off its blood supply.
Within four to six hours after symptoms arise, an affected testis can typically be saved through surgical treatment that untwists its spermatic cord and restores blood flow.
Testicular Rotation
Testicular torsion, an emergency condition requiring prompt medical intervention, usually affects one side of male bodies at once; but occasionally both sides. When this happens, its attachments become dislocated, leading it to twist in on itself and stop receiving blood flow – leading to death of the testicle itself if untreated quickly. Testicular torsion typically affects only one side, although both may sometimes be affected.
Torsion occurs when the spermatic cord, which runs upward from each testicle and downward to the scrotum, becomes twisted, cutting off blood flow to that testicle and potentially leading to its destruction. Torsion most often affects newborns but may affect children at any age; male athletes who participate in strenuous physical activities or sports are at greater risk.
Testicular Torsion can cause pain, swelling and a sensation that the scrotum is full or heavy, as well as bruised appearance or hard and firm feel in one or both testicles. Newborns rarely feel anything during torsion diagnosis which usually comes through parent notification of swollen scrotums or during routine exams by medical practitioners.
Testicular torsion diagnosis requires an accurate history and immediate imaging of the scrotum using ultrasound or radioisotope scanning; ultrasound tends to identify problems more rapidly and detect any damage to testicle from torsion more effectively than radioisotope scans can. Salvage rate increases if detorsing occurs within four hours of symptoms appearing and declines substantially if over eight hours pass without intervention;
Ultrasound
Ultrasound (also called ultrasonography or sonography) uses sound waves to create images of organs and structures within your body using sonar technology. Your healthcare provider can view images of internal organs, blood vessels and lymph nodes; detect cancerous tumors; as well as detect abnormal growths within soft tissue structures like lymph nodes. Ultrasound testing is painless and noninvasive with results available immediately for viewing.
An ultrasound test involves applying a small amount of gel to the area being examined and moving a transducer over it. Sonar (sound) waves from between transducer and body structures will then be recorded on video monitor and processed by computer into an image of what’s being examined.
Ultrasound can often serve as a valuable aid during biopsies, helping doctors locate mass in the breast or groin before extracting samples for testing. Ultrasound also can show movement of fluids within the body – for instance it can reveal where urethral diverticulums exist – which are conditions which cause frequent urinary tract infections.
Point-of-care ultrasound has proven useful in diagnosing testicular torsion with high sensitivity and specificity when performed by emergency physicians7. It is imperative that this test be performed as soon as possible as any delays could lead to testicular necrosis and loss. A lack of or diminished testicular blood flow on ultrasound and/or the presence of the whirlpool sign are both indicators of torsion.
Urinalysis
Urinalysis is an in-office test designed to examine your urine for signs of illness or disease. It can detect kidney disease and urinary tract infections (UTIs) before their symptoms arise, making this an invaluable health screening test. You will typically be instructed by your physician to urinate briefly into a specimen cup – making sure your sample does not become contaminated by bacteria from penis skin or tissues within vagina, which could skew results and compromise results.
An urinalysis involves testing your urine both chemically and microscopically. The chemical examination uses a dipstick to reveal its pH and concentration while testing for chemicals like red blood cells, white blood cells, sugar, nitrites, proteins, urea, creatinine, leukocyte esterase, ketone bodies, and bilirubin. Finally, microscopic analysis includes looking for crystals, casts (tube-shaped proteins) or bacteria present.
Drugs and supplements, including over-the-counter medicines, may affect your urinalysis results. Before going in for testing, inform your physician of any drugs, vitamins or herbal remedies you are currently taking; fasting may also be advised depending on why you were tested in the first place. Your physician may suggest scheduling another test or visit to discuss results and next steps depending on why testing was initially recommended.
Doppler
Doppler ultrasound tests measure blood flow through your body’s blood vessels by using sound waves that bounce off red blood cells moving through them and return with different echoes depending on their speed of travel – this phenomenon is known as the Doppler effect and was first identified by Christian Doppler during his research in the 1800s. A computer then interprets these echoes into an image depicting your speed and direction of blood circulation within each vessel in your body.
Doppler can be used to assess circulation in your neck’s two major arteries – known as carotid arteries – which is also called “carotids.” This test allows doctors to identify blockages that could potentially lead to strokes and detect clots in them, among other uses.
This test involves passing a small device (either the sonographer’s hand or wand-like machine) over the area of neck being examined, after applying gel. Once in position, this device sends out series of high-frequency sound waves; recording their echos with computer analysis is then conducted on them.
Doppler tests are an invaluable diagnostic tool in torsion medicine, enabling clinicians to detect signs of torsion testicle rotation early during pre-surgical evaluation. Torsed testicles will show diminished or absent blood flow on Doppler ultrasound imaging and appear hypoechoic compared with an untorsed one.
Pediatrics researchers recently conducted a study that revealed how Doppler ultrasound can significantly increase diagnostic accuracy when used within 60 minutes after intermediate clinical suspicion of testicular torsion has emerged, when compared with standard clinical assessment alone. Doppler also helps prevent delays in surgical exploration that could cause permanent ischemic damage or orchiectomy due to lack of surgical exploration within that same timeframe.
Manual Detorsion
Manual detorsion is an in-bed therapeutic that has been shown to shorten the duration of testicular ischemia and, when conducted promptly, can save a testicle. Manual detorsion works by gently turning away from the spermatic cord any testicular tissue that has become stuck, similar to opening a book. Ultrasound imaging helps guide physicians when performing this bedside therapeutic. One study highlighted sonographic indications for manual detorsion such as absence or decreased blood flow within affected testis, abnormal echogenicity or swelling due to testis or epididymis due to testis and epididymis ischemia.
Immediately upon suspecting testicular torsion, a scrotal ultrasound should be obtained for evaluation. This may be done while waiting for surgical consultation; however, an ultrasound isn’t necessarily needed in all instances where there is testicular pain as other conditions such as epididymitis or an incarcerated hernia may also contribute.
When an ultrasound shows high probability for torsion, a urologist should be immediately consulted in order to perform manual detorsion and orchiopexy. If a urologist cannot be reached immediately or is delayed in responding, emergency physicians should attempt to rotate the testicle medially instead of laterally as this has proven more successful in treatment.
While no consensus exists as to the optimal technique for manual detorsion, typically physicians will stand with a supine patient and manually rotate his testicle away from its midline (right testicle clockwise, left testicle counterclockwise [the open-book technique]). Pain medication may be administered; however, pain does not always indicate success of detorsion maneuver. Therefore, subsequent ultrasound confirmation must occur to verify untwisting of spermatic cord.
