Testicular torsion occurs when a testicle rotates, twisting the spermatic cord that supplies blood to the scrotum which in turn causes sudden and severe pain.
Though it can occur at any age, testicular torsion is most common between ages 12 and 18, and even before birth.
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Testicular torsion is a medical emergency which requires surgery. The testicle can mostly be saved if treated on time. However, when blood flow has been cut off for a long time, a testicle might be so badly damaged that the last resort is for it to be removed.
Symptoms of Testicular torsion
Signs and symptoms of testicular torsion include:
- Swelling of the scrotum
- Severe pain in the scrotum — the loose bag of skin under your penis that contains the testicles
- Nausea and vomiting
- Abdominal pain
- Testicle that is positioned at an unusual angle
- Frequent urination
Young boys who have testicular torsion typically wake up due to scrotal pain in the middle of the night or early in the morning.
Causes of Testicular Torsion
It’s still not clear why testicular torsion occurs. Testicular torsion occurs when the testicle rotates on the spermatic cord, which supplies blood to the testicle from the abdomen. If the testicle rotates several times, blood flow to it can be totally blocked, causing damage.
Most males who get testicular torsion have an inherited trait that allows the testicle to rotate freely inside the scrotum, in most cases, it often affects both testicles.
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Testicular torsion often occurs several hours after forceful activity or after a minor injury to the testicles or while sleeping. Also, cold temperature or rapid growth of the testicle during puberty can also be responsible for testicular torsion.
When to see a doctor
You should seek emergency care for sudden or severe testicle pain. Timely medical intervention can prevent severe damage or loss of your testicle.
Also, seek immediate help if you’ve had sudden testicle pain that goes away without treatment. This can occur when a testicle twists and then untwists on its own (intermittent torsion and detorsion). Surgery is frequently needed to prevent the problem from reoccurring.
- Testicular torsion is most common between ages 12 and 18.
- Previous testicular torsion.If you’ve had testicular pain that went away without treatment, it’s likely to occur again.
- Family history of testicular torsion.The condition can run in families in most cases.
Testicular torsion can cause the following complications:
- Damage to or death of the testicle. When testicular torsion is not treated for several hours, it can cause permanent damage to the testicle or blocked blood flow. If the testicle is badly damaged, it has to be removed surgically.
- Damage or loss of a testicle can affects a man’s ability to have children.
Surgery is the only way to prevent testicular torsion. This procedure attaches both testicles to the inside of the scrotum
Your doctor will ask questions to validate whether your signs and symptoms are caused by testicular torsion or something else. Doctors diagnose testicular torsion by conducting a physical exam of the abdomen, scrotum, testicles, and groin.
Your doctor might also test your reflexes by lightly rubbing or pinching the inside of your thigh on the affected side. This usually causes the testicle to contract. For someone with testicular torsion, this reflex might not occur.
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Sometimes medical tests are necessary to confirm a diagnosis or to help identify another cause for your symptoms. Such as:
- Urine test.This test is used to check for infection.
- Scrotal ultrasound.This type of ultrasound is used to check blood flow. Decreased blood flow to the testicle is a sign of testicular torsion. However, ultrasound doesn’t always detect the reduced blood flow.
- Surgery might be necessary to determine whether your symptoms are caused by testicular torsion or an underlying condition.
If you’ve had pain for several hours and your physical exam suggests testicular torsion, you might be taken directly to surgery without any additional testing. Delaying surgery might result in loss of the testicle.
Surgery is mostly needed to correct testicular torsion. In some instances, the doctor might be able to loosen the testicle by pushing on the scrotum (manual detorsion). However, you’ll still need surgery to prevent torsion from reoccurring.
Surgery for testicular torsion is performed under general anesthesia. Your doctor will make a small incision 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 can be saved. After six hours from the start of pain, the chances of needing testicle removal are greatly increased. Your chance of needing testicle removal may be higher if treatment is delayed more than 12 hours from the beginning of pain.
Testicular torsion in newborns and infants
Though it’s rare, but testicular torsion can occur in newborns and infants. The infant’s testicle might be hard, swollen or a darker color. Ultrasound might not detect reduced blood flow to the infant’s scrotum, so surgery might be required to confirm testicular torsion.