TESTICULAR TORSION – SYMPTOMS, CAUSES, AND TREATMENT
Testicular torsion happens when a testicle rotates, twisting the spermatic cord that brings blood to the scrotum. The reduced blood flow causes unexpected and often severe pain and swelling.
Testicular torsion is most common between ages 12 and 18, but it could happen at any age, even before birth.
Testicular torsion generally needs emergency surgery. If treated quickly, the testicle could usually be saved. But when blood flow has been cut off for too long, a testicle may become so badly damaged that it has to be removed.
Signs and symptoms of testicular torsion include:
- Sudden, severe pain in the scrotum — the loose bag of skin under your penis that consists of the testicles
- Swelling of the scrotum
- Abdominal pain
- Nausea and vomiting
- A testicle that is positioned higher than usual or at an unusual angle
- Frequent urination
Young boys who have testicular torsion typically wake up because of scrotal pain in the middle of the night or early in the morning.
WHEN SHOULD YOU SEE A DOCTOR?
Seek emergency care for unexpected or severe testicle pain. Prompt treatment could prevent severe damage or loss of your testicle if you have testicular torsion.
You also need to seek prompt medical help if you have had sudden testicle pain that goes away without treatment. This could happen when a testicle twists and then untwists on its own (intermittent torsion and detorsion). Surgery is frequently required to prevent the problem from happening again.
Testicular torsion happens when the testicle rotates on the spermatic cord, which brings blood to the testicle from the abdomen. If the testicle rotates several times, blood flow to it could be completely blocked, causing damage more quickly.
It is not clear why testicular torsion happens. Most males who get testicular torsion have an inherited trait that enables the testicle to rotate freely inside the scrotum. This inherited condition usually affects both testicles. However, not every male with the trait will have testicular torsion.
Testicular torsion often happens several hours after vigorous activity, after a minor injury to the testicles, or while sleeping. Cold temperature or quick growth of the testicle during puberty also may play a role.
- Age – Testicular torsion is most frequent between ages 12 and 18.
- Previous testicular torsion – If you have had testicular pain that went away without treatment (intermittent torsion and detorsion), it is likely to happen again. The more common the bouts of pain, the higher the risk of testicular damage.
- Family history of testicular torsion – The condition could run in families.
Testicular torsion could cause the following complications:
- Damage to or death of the testicle – When testicular torsion is not treated for several hours, blocked blood flow could cause permanent damage to the testicle. If the testicle is severely damaged, it has to be surgically removed.
- Inability to father children – In some cases, the damage or loss of a testicle affects a man’s ability to father children.
Having testicles that could rotate in the scrotum is a trait inherited by some males. If you have this trait, the only way to prevent testicular torsion is by surgery to attach both testicles to the inside of the scrotum.
Your doctor will ask you questions to confirm whether your signs and symptoms are caused by testicular torsion or something else. Doctors usually diagnose testicular torsion with a physical examination of the scrotum, testicles, abdomen, and groin.
Your doctor may also test your reflexes by gently rubbing or pinching the inside of your thigh on the affected side. Generally, this causes the testicle to contract. This reflex may not happen if you have testicular torsion.
Sometimes medical tests are essential to confirm a diagnosis or to help identify another cause for your symptoms. For example:
- Urine test – This test is used to examine for infection.
- Scrotal ultrasound – This type of ultrasound is used to examine blood flow. Reduced blood flow to the testicle is a sign of testicular torsion. But ultrasound does not always detect the reduced blood flow, so the test may not rule out testicular torsion.
- Surgery – Surgery may be necessary to determine whether your symptoms are caused by testicular torsion or another condition.
If you have had pain for several hours and your physical examination suggests testicular torsion, you may be taken directly to surgery without any additional testing. Delaying surgery may result in loss of the testicle.
Surgery is needed to correct testicular torsion. In some instances, the doctor may be able to untwist the testicle by pushing on the scrotum (manual detorsion). But you will still need surgery to prevent torsion from happening again.
Surgery for testicular torsion is generally done under general anesthesia. During surgery, your doctor will make a tiny cut in your scrotum, untwist your spermatic cord, if necessary, and stitch one or both testicles to the inside of the scrotum.
The sooner the testicle is untwisted, the greater the chance it could be saved. After six hours from the start of pain, the chances of needing testicle removal are highly increased. If treatment is delayed more than twelve hours from the start of pain, there is at least a 75 percent chance of needing testicle removal.
Testicular torsion in newborns and infants
Testicular torsion could happen in newborns and infants, though it is rare. The infant’s testicle may be hard, inflamed, or a darker color. Ultrasound may not detect reduced blood flow to the infant’s scrotum, so surgery may be needed to verify testicular torsion.
Treatment for testicular torsion in infants is a controversial issue. If a boy is born with signs and symptoms of testicular torsion, it may be too late for emergency surgery to help and there are risks related to general anesthesia. But emergency surgery could sometimes save all or part of the testicle and could prevent torsion in the other testicle. Treating testicular torsion in infants may prevent future problems with male hormone production and fertility.
If you or anyone you know is suffering from testicular torsion, our expert providers at Specialty Care Clinics will take care of your health and help you recover.
Call us on (469) 545-9983 to book an appointment with our specialists.