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What Is Testicular Torsion?
In torsion, the testicle is inadequately attached to the scrotum, allowing it to rotate freely within. This can lead to twisting of the testicle about the blood vessels to which it is connected, cutting off blood flow and leading to severe pain and the eventual death of the testicle . Testicular torsion can occur spontaneously, after several hours of exercise, or after an event such as trauma to the scrotum.
Symptoms include testicular pain, swelling, tenderness and rotation or higher positioning, as well as nausea, vomiting and fever .
Treatments include manual de-torsion, which is a temporary fix, and necessary emergency surgery in order to salvage the affected testicle.
Testicular torsion is likely to require emergency surgery. You should go to the nearest ER.
Testicular Torsion Symptoms
Symptoms of testicular torsion primarily include testicular pain, but may also include testicular deformity and more widespread effects due to discomfort.
In most cases, testicular torsion is felt as abrupt-onset testicular pain that can be described in a few different ways.
- Radiating: This pain may radiate to the groin or lower abdomen and is constant.
- Experienced in one testicle: Usually this pain will only affect one testicle, but this may be hard to determine depending on its severity.
- Relieved by elevation: In some individuals, elevating the testicle will lead to minor relief of the pain.
- Intermittent torsion: The exception to the above rules is "intermittent torsion," where the testicle spontaneously twists and untwists itself, lead to abrupt-onset and then rapid resolution of the pain and other symptoms.
As the testicle twists, it first cuts off the low-pressure blood flow that is exiting the scrotum. This leads to swelling since blood can enter but not exit the area. This can cause the scrotum to:
- Appear swollen: The scrotum may enlarge and appear swollen, warm, and red.
- Feel tender: It will likely be tender to the touch. The testicle may also feel hard when you touch it.
- Be rotated or positioned higher: The testicle is often positioned higher in the scrotum than the unaffected testicle on the other side. You may also notice that it is rotated in a different direction.
Other symptoms you may experience include:
- Nausea and vomiting: Up to nine out of 10 people with testicular torsion will experience severe nausea and vomiting associated with their testicular pain.
- Fever: The inflammation from testicular torsion can cause a low-grade fever in some individuals, but this symptom is not as common as the other three.
Testicular Torsion Causes
Testicular torsion is predominantly believed to be the result of a minor developmental defect involving the scrotum and the testicles. It usually occurs in adolescent males or those with a family history.
Understanding Testicular Anatomy
To better understand testicular torsion , you need to know a little bit about the anatomy of the testicle, also known as the testis.
- Location: Most men have two testicles, one on each side of the scrotum. These egg-shaped organs function as the starting point for the production of sperm, the male reproductive cell.
- Function: Each testis hangs in the scrotum via the "spermatic cord," which provides blood flow, and is loosely fixed in place to a structure called the "tunica vaginalis."
- How twisting occurs: When this structure is absent or there is insufficient attachment, the testicle can twist about the spermatic cord, become stuck, and cut off the blood flow it needs to survive.
Who is most likely to be affected
Testicular torsion happens most often in:
- Adolescent male** s:** The vast majority of such cases, nearly 70 percent, happen in adolescent males between the ages of 12 to 18 . However, torsion can occur at any age.
- Those with a family history or previous diagnosi** s:** If you have previously had testicular torsion or have a family history of this condition, you are more likely to experience it . Rarely, a testicular tumor may be present that initiated the torsion. Some individuals experience "intermittent torsion" in which they experience symptoms that spontaneously resolve as the testicle untwists itself.
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Treatment Options and Prevention for Testicular Torsion
Treatment of testicular torsion requires an immediate visit to the hospital, as this condition is extremely time-sensitive and often calls for urgent surgery. If this condition is not fixed quickly (within six to 12 hours), the testicle will be severely damaged and it will unlikely be saved [1,2,3].
As a temporary fix for testicular torsion, the issue can be resolved manually.
- Procedure details: A physician will manipulate the testicle within the scrotum to attempt to rotate it back into its normal position . Pain relief will be provided to make the procedure more tolerable.
- Prognosis: This is a temporary rather than a permanent fix, which can restore blood flow and buy time while you await definitive treatment.
You will ultimately need surgery to fix testicular torsion because there still might be some residual twisting and there is a high probability that the torsion will occur again.
Procedure details: In this surgery (orchiopexy), a urologist will open the scrotum, untwist the testicle, and then fix it in place to prevent rotation in the future . They will often do the same procedure to the other testicle as well, as the same defect is usually present on both sides.
Prognosis: The condition will resolve, and you should feel much better besides the residual pain and fogginess caused by the surgery. It is unlikely that your testicular torsion will recur.
There is no good way to prevent testicular torsion as there is no way for you to tell if you are at high risk of this condition. The best thing you can do is pay attention if you start to experience severe testicular pain. There is a significant risk of long-term testicular complications without treatment; however, similar research regarding effects on fertility are somewhat uncertain .
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When to Seek Further Consultation for Testicular Torsion
If you experience any of the symptoms of testicular torsion, especially after trauma to your genital region, it is critical that you seek medical attention immediately.
Preventing further damage
If you are experiencing torsion, you will need an urgent consultation with a urologist for prompt surgical management in order to save the affected testicle and prevent torsion in the unaffected one. Damage to the testicle begins to occur after six hours, and after just 12 hours, there is a significant chance (75 percent) the testicle will be irreparably damaged and cannot be saved . This may affect your sterility and ability to have children.
What to expect in the emergency room
In the emergency department, you can expect to receive a full work-up. A physician may order an ultrasound of your scrotum to evaluate the blood flow to the region. He or she may also attempt manual de-torsion to restore some blood flow.
What to expect after surgery
Surgery, as described above, is generally required to treat this condition even if it resolves spontaneously or with manual de-torsion, as it tends to happen again. Often the other testicle is at high risk of torsion as well. If you are unable to get medical treatment within the 12-hour window, you should still attempt to get to a physician quickly. Sometimes, the torsion you have experienced was not "complete" and there may be some testicular tissue that is salvageable with surgery.
Questions Your Doctor May Ask to Determine Testicular Torsion
To diagnose this condition, your doctor would likely ask about the following symptoms and risk factors.
- Are you sick enough to consider going to the emergency room right now?
- Have you lost your appetite recently?
- How has the intensity of your vomiting changed over time?
- How long has your vomiting been going on?
- How many times have you vomited in the last 24 hours?
If you've answered yes to one or more of these questions
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- Testicular torsion. The Mayo Clinic. Mayo Clinic Link. Published May 5, 2018.
- Sharp VJ, Kieran K, Arlen AM. Testicular Torsion: Diagnosis, Evaluation, and Management. Am Fam Physician. 2013;88(12):835-840. AAFP Link.
- Shteynshlyuger A, Yu J. Familial testicular torsion: a meta analysis suggests inheritance. J Pediatr Urol. 2013;9(5):683-90. NCBI Link.
- Ringdahl EN, Teague L. Testicular Torsion. Am Fam Physician. 2006;74(10):1739-43. AAFP Link.
- Taskinen S, Taskinen M, Rintala R. Testicular torsion: orchiectomy or orchiopexy? J Pediatr Urol. 2008;4(3):210-3. JPU Link.
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