- What is Testicular Torsion?
- Testicular Torsion Symptoms
- Testicular Torsion Causes
- Testicular Torsion Treatment
- Blood/ Urine tests
- Scrotal Ultrasound
- Nuclear Scan
- Newborns and infants with testicular torsion
- After birth
- Before birth
What is Testicular Torsion?
This is a condition which can develop when a testicle revolves on the spermatic cord. This is the cord that delivers the flow of blood to the testicles; so naturally, this revolution cuts off the flow of blood and swiftly causes severe pain as well as swelling. This problem is most frequently seen in males who are 10 years old to 25 years old, but it also may happen at any age.
Testicular torsion normally necessitates surgery which is considered emergency. If this condition is medically treated inside of a few hours, the testicle can normally be saved. But if waiting too long to get treatment this condition can create damage which is enduring and can as well affect the capacity to father any children. In fact when blood flow has been interrupted for much too long, the testicle involved may become so damaged that it will be necessary to be removed.
Testicular Torsion Symptoms
Symptoms and signs of testicular torsion consist of:
- Abrupt and/or severe pain in one testicle
- Tenderness in testicle
- Enlargement of testicle
- Swelling of the scrotum – which is the bag of skin under the penis which contains the testicles
- Vomiting as well as nausea
- Pain in the abdomen
- Testicle which is positioned higher than standard or is at an odd angle
- Sudden pain in the testicle which leaves without treatment – this occurs because the testicle twists and then on its own untwists – sporadic torsion and detorsion.
When a male experiences severe or sudden pain in the testicle, they need to seek emergency medical care immediately. While the symptoms and signs can be triggered by other conditions, if the problem is testicular torsion, treatment needs to be as quickly as possible in order to avoid severe harm or the loss of a testicle. If the twisted testicle goes away on its own the doctor still needs to be seen as surgery could be needed in order to prevent this condition from continuing to happen.
Additional symptoms which can be associated with this condition include:
- Testicle lump
- Blood in semen
Testicular Torsion Causes
Within the scrotum, the testicles are both secured at either end by the spermatic cord. Often, this cord can get twisted around one of the testicles which cuts off the supply of blood to that testicle. This can result in shrinkage or atrophy as well as tissue death or necrosis. The cause of most cases is known as the “bell clapper” deformity which is an anatomic abnormality that is seen in approximately 12% of males.
Many men may be susceptible to this condition because of inadequate connective tissue in the scrotum. But, the condition can also result from some trauma to the scrotum, especially if substantial swelling had occurred. It can also occur after exercise which is very strenuous or can happen for no obvious reason.
This problem is fairly common during infancy – usually the 1st year of life and at the beginning of adolescence – puberty. But it occurs most frequently in young males less than 25 years of age.
In boys and men who are at risk for this condition, the testicular torsion often happens with no apparent trigger. It can frequently start following:
- An injury to the scrotum
- Physical activity
Risk factors can include:
- Previous testicular torsion
Testicular Torsion Treatment
Medical professionals will ask the individual numerous questions to validate if the symptoms and signs are indeed caused by testicular torsion or some other condition. The physician will examine the scrotum, abdomen, testicles as well as the groin. The reflexes will also be tested by lightly rubbing or punching the inside of the thigh on the side which is affected. Usually this will cause the testicle to contract. If testicular torsion is not present, this reflex will usually not occur.
Blood/ Urine tests
Blood or urine tests, to determine whether the symptoms or signs are triggered by an infection
Scrotal ultrasound, using sound waves which are high-frequency and generate images of the testicle as well as check for flow of blood.
Nuclear scan of the testicles, which comprises the injection of small quantities of radioactive matter into the blood system. Using a special camera, it is possible to identify areas in the testicles which receives less blood, indicating torsion.
Often surgery is needed to identify if the symptoms are indeed testicular torsion or other problems. If there is pain for a number of hours and the physical exam suggests testicular torsion, the individual may be taken directly to surgery without additional testing. Any further testing could cause delay of blood flow into the testicle and hinder any attempts to save that testicle.
In several cases, the physician might be able to untwist the testicle by pushing on the scrotum but the patient will still need surgery to prevent this from occurring again. Surgery for testicular torsion occurring at birth is not possible.
Surgery for this condition is normally done with general anesthesia, which means that the patient is not conscious. This surgery does not generally require a stay in the hospital. The physician will:
- Make cut in scrotum
- Untwist the spermatic cord
- Stitch one or possibly both testicles to the inside of the scrotum in order to prevent rotation occurring again.
The quicker the testicle is untwisted, the greater the chance of a successful outcome.
Within 6 hours, the testicle can be saved in approximately 90% of the time. After 12 hours, the chances of saving the testicles fall to approximately 50%. After the 24 hour mark, the testicle can only be saved in about 10% of the time.
After surgery, strenuous activity including sexual activity will need to be avoided for several weeks.
Newborns and infants with testicular torsion
In some cases, surgery is needed to not only correct but also to diagnose this condition. This will stop future issues with any infertility or male hormone production. The tough decision for the parents is deciding whether a newborn or infant should have surgery and the answer usually depends on the judgment of the baby’s doctor along with the wishes of the parents.
If a boy is born with symptoms or signs of testicular torsion, it can be too late for emergency surgery to help. In some cases, the physician may suggest a later, nonemergency surgery.
If symptoms and signs of this condition occur after birth, the doctor may recommend emergency surgery.
Having testicles which can rotate or swing freely in the scrotum is an inherited trait that occurs in some males and does not in others. The only way to prevent testicular torsion in individuals who have this trait is with surgery to attach both testicles to the inside of the scrotum in order for them to not rotate freely.