Testicular torsion

What is Testicular torsion?

Testes are the reproductive organs situated in the scrotum. These are suspended and connected to the rest of the body by a cord like structure called spermatic cord. This cord carries the blood flow to and from the testes. Sometimes testis can twist around this spermatic cord which is known as testicular torsion. When this happens, the blood supply may get cut off to testis either completely or partially which needs an emergency surgical repair.

What are the symptoms and when should I see the doctor?

Testicular torsion will present as severe testicular pain, sometimes pain spreading to groin and lower abdomen. Swelling can also be seen associated with pain. You may have additional symptoms like vomiting, sweating etc

Scrotum may be swollen and dark especially if pain persists for longer duration. One should seek medical help as soon as possible  (usually within 2-4 hours of pain onset) failing which blood supply to testis may get completely stopped, the testis may die and become non functional.

Why does torsion occur in testis?

Torsion is not a common problem and is seen in approximately 1 in 4,000 males under the age of 25. It can also happen in newborns and in older men.

In most males, a testis cannot twist because the tissue around it is well attached. Some males are born with no proper tissue holding the testes to the scrotum. This lets the testes "swing" and “curl” inside the scrotum (often called a "bell clapper" deformity).

Torsion can happen on either side, but rarely on both sides. It may happen during vigorous exercise or severe cough. However it may occur even spontaneously without any triggering factor.

How is it diagnosed?

Testicular torsion can be diagnosed easily by clinical examination. But sometimes the diagnosis is challenging (during the initial stages) and need to be differentiated with infection or trauma. In such cases, an emergency ultrasonography is needed to confirm the diagnosis as well as to check the blood flow to the testis.

However your clinician may decide to explore and operate immediately without wasting time to get an ultrasound as its an emergency situation.

What is the treatment?

The spermatic cord needs to be untwisted (de-torsion) to restore the blood supply. Permanent damage starts occurring after 6 hours of torsion. Nearly 3 in 4 patients may lose the testis if delay in treatment beyond 8-10 hours. In such a case, the dead testis needs to be removed ("orchidectomy").

All patients with torsion will need surgery. It is possible to untwist the cord in the emergency room, but surgery is still needed to fix the testis. At surgery, the urologist will untwist the testicle and sew stitches to prevent future torsion. The same steps are often repeated on the opposite normal testis also to prevent future torsion. If the testis cannot be saved and is dead, the urologist will remove the testis.

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