Testicular torsion is a critical medical emergency that occurs when the spermatic cord, responsible for supplying blood to the testicle, twists. This twisting action cuts off the blood flow to the testicle, leading to sudden and severe pain, often accompanied by swelling. Prompt medical intervention, typically surgery, is essential to save the testicle. If left untreated for more than a few hours, testicular torsion can cause irreversible damage, potentially necessitating the removal of the affected testicle.
What Happens During Testicular Torsion?
Testicular torsion involves the spermatic cord, the vital structure carrying blood vessels, nerves, and the vas deferens, twisting upon itself. This twisting disrupts the crucial blood supply to the testicle.
When the spermatic cord twists, the immediate consequence is a cutoff of blood flow to the testicle. This lack of blood supply, known as ischemia, causes rapid onset of pain and swelling in the affected testicle. This is a clear signal that immediate medical attention is required.
Recognizing the Signs and Symptoms of Testicular Torsion
If you are experiencing testicular torsion, the symptoms are usually unmistakable. It’s crucial to recognize these signs and seek help immediately. The primary symptom is intense and sudden pain in the scrotum and testicle.
Even if the initial severe pain subsides temporarily, it is still vital to seek medical attention. Testicular torsion is a condition that requires professional medical evaluation, regardless of pain fluctuations. Ignoring the symptoms can lead to serious complications.
The Urgency of Testicular Torsion: Time is Testicle
The duration of testicular torsion is a critical factor in determining the outcome. The longer the spermatic cord remains twisted and blood flow is restricted, the greater the risk of permanent damage to the testicle.
Ignoring the pain or hoping it will resolve on its own can lead to severe and irreversible damage to the testicle, potentially resulting in testicle loss. Prompt action is paramount in managing testicular torsion effectively.
Who is at Risk for Testicular Torsion?
Testicular torsion can affect males of any age, though it is most prevalent in adolescents and teenagers. While it is most common in the 12 to 18-year-old age group, it can also occur in younger boys and adult men.
In many instances, there is no identifiable cause for testicular torsion. It can occur spontaneously, after minor trauma, during physical activity, or even during sleep. The unpredictable nature of testicular torsion underscores the importance of recognizing the symptoms and seeking immediate medical care whenever they arise.
Seeking Help and Treatment for Testicular Torsion
Discussing issues related to the testicles can be uncomfortable for some. However, in the case of testicular torsion, overcoming any embarrassment and seeking prompt medical help is crucial.
Doctors typically perform surgery to correct testicular torsion. For individuals who seek treatment promptly, surgery is often successful in resolving the issue and preserving the testicle. Even in cases where a testicle is lost due to torsion, it’s important to know that men can still lead normal sexual lives and father children with one healthy testicle.
Causes of Testicular Torsion: The Bell Clapper Deformity
The scrotum is the pouch of skin beneath the penis that houses the testicles. Inside the scrotum are the two testicles, each connected to the body via the spermatic cord. Testicular torsion arises when this spermatic cord twists, impeding blood flow to the attached testicle.
A significant predisposing factor for testicular torsion is a condition known as the bell clapper deformity. In most males, the testicles are anchored to the scrotum, which limits their mobility and prevents twisting. However, in individuals with the bell clapper deformity, the testicles are not securely attached and can move and rotate freely within the scrotum. This increased mobility makes them more susceptible to twisting.
Testicular torsion predominantly affects males between 12 and 18 years old, but it can occur at any age. Triggers can include strenuous physical activity, sleep, or even minor scrotal injuries. However, in many cases, no specific cause is identified.
Symptoms of Testicular Torsion: Recognizing the Emergency Signs
The primary symptom of testicular torsion is sudden, intense pain in the scrotum and testicle. This pain may fluctuate in intensity but generally persists. Other symptoms include:
- Swelling in the scrotum, especially on one side
- Nausea and vomiting
- Abdominal pain
- One testicle positioned higher than the other
What to Do If You Suspect Testicular Torsion
If you experience sudden scrotal pain, it is essential to contact a doctor immediately and proceed to the nearest hospital or emergency room without delay. It is crucial to refrain from eating or drinking anything until a doctor has evaluated the condition and determined if surgery is necessary. Testicular torsion is a medical emergency requiring rapid intervention. The faster treatment is initiated, the higher the likelihood of saving the testicle.
As a general guideline regarding the timeframe for treatment:
- Within 4-6 hours of symptom onset, the testicle salvage rate is approximately 90%.
- Between 12 hours, the salvage rate decreases to around 50%.
- After 24 hours, the chance of saving the testicle drops significantly to only about 10%.
Sometimes, a spermatic cord may twist and then spontaneously untwist, a phenomenon known as torsion and detorsion. While the pain may subside after spontaneous detorsion, it’s crucial to seek medical evaluation. Torsion and detorsion increases the risk of future testicular torsion. Medical intervention can help prevent recurrence.
Immediate Medical Attention is Crucial
While discussing private health matters can be sensitive, it is vital to inform a parent, guardian, or doctor immediately if you experience scrotal pain. Delaying treatment or hoping the pain will disappear can have severe consequences, potentially leading to irreversible testicular damage and possible testicle removal.
Even if scrotal pain resolves on its own, it’s still important to consult a doctor. A previous torsion event increases the likelihood of future occurrences. Doctors can perform a simple surgical procedure to secure the testicles to the scrotum, significantly reducing the risk of future torsion.
Diagnosing Testicular Torsion: Prompt and Accurate Assessment
Upon arrival at a medical facility and describing the symptoms, medical professionals will often presume testicular torsion, even while considering other potential diagnoses.
A physical examination will be conducted, involving assessment of the scrotum, testicles, abdomen, and groin. Reflexes may be tested by gently stimulating the inner thigh, which normally causes the testicle to contract. This reflex may be absent in cases of testicular torsion.
Diagnostic tests to confirm testicular torsion and assess spermatic cord twisting may include:
- Ultrasound: Doppler ultrasound utilizes high-frequency sound waves to create images of the testicle and assess blood flow. Reduced or absent blood flow can indicate torsion.
- Urine and Blood Tests: These tests can help rule out infection as the cause of pain and symptoms.
In some situations, surgical exploration may be necessary to definitively diagnose testicular torsion. In cases of prolonged torsion or high suspicion based on examination, immediate surgery may be performed to save the testicle, without waiting for other diagnostic tests.
Treatment Options for Testicular Torsion: Surgical Intervention
Testicular torsion typically requires surgery to correct. In rare instances, a doctor may attempt manual detorsion by manipulating the scrotum. However, surgery is usually necessary to secure both testicles to the scrotum to prevent future torsion.
Surgery for testicular torsion is often an outpatient procedure. Under pain relief and general anesthesia, a surgeon or urologist makes a small incision in the scrotum, untwists the spermatic cord, and sutures both testicles to the inner scrotum to prevent recurrence. The scrotum is then closed with stitches. Recovery typically involves a few hours in the hospital or clinic.
The surgical procedure to fix testicular torsion usually takes around 45 minutes. Post-operative pain is manageable and significantly less severe than the pain of torsion.
In cases where torsion has persisted for an extended period, and the testicle is no longer viable, a procedure called orchiectomy (testicle removal) may be necessary.
Post-Surgery Care and Recovery
Following testicular torsion surgery, it’s important to avoid strenuous activities, including sports, and sexual activity or stimulation for several weeks. Consult your doctor for specific guidelines on when it is safe to resume normal activities.
Even after testicle removal due to torsion, individuals can live full and normal lives. Most men retain fertility and sexual function with one healthy testicle. Some men may choose to undergo prosthetic testicle implantation a few months after surgery for cosmetic reasons, to improve body image and self-esteem.
