Testicular Torsion

Testicular torsion is also called testis torsion. When a testicle rotates, twisting spermatic cords and blood vessels, testicular torsion occurs. This twisting of the cords results in the cutting off of the testicles’ blood supply. This then leads to severe pain and swelling. The twisting amount can range from 180 to 720 degrees, and this in turn affects the density of damage to the testicles. Hence, it is recommended to reach out to the nearest healthcare within four to six hours of torsion occurring, since there is a 90% chance of saving the testicles. As the hours pass, the percentage of saving the testicles drops. Once the time increases to twelve hours after torsion, the chances drop to 50%, and if it is delayed twenty-four hours, there is only a 10% chance of saving the testicle.

Severe pain and swelling are caused due to obstruction in the blood flow. Testicular torsion is commonly seen in boys aged twelve to sixteen years, but it can occur at any age.

The condition requires emergency surgery. If treated quickly, the affected testicle can be saved. However, if one delays treatment and the testicular torsion goes on for a couple more hours, it can lead to permanent damage to the testicle.

When blood flow has been cut off for too long, removal of the testis is required.

Signs and symptoms of testicular torsion include:

• Swelling of the scrotum, especially on one side
• One testicle seeming higher than the other
• Severe pain in the scrotum
• Abdominal pain
• Painful urination
• Fever
• Nausea
• Vomiting

Often, the pain of testicular torsion is so severe that it disrupts sleep.

The exact cause of testicular torsion is not known.

When a testicle rotates along with the spermatic cord and blood vessels, which supply blood to the testicles, it leads to the development of testicular torsion.

It is not yet clear why testicular torsion occurs. There is an inherited gene that allows the testicle to rotate freely inside the scrotum. It may affect both testicles. The scrotum looks like a sack of skin that lies beneath the penis. There are two testes present inside the scrotum. Testes are also called testicles. Each testicle is also connected to the rest of the body with the help of the blood vessel called the spermatic cord, hence, twisting affects the testicles and results in testicular torsion.

Testicular torsion often occurs after vigorous activity or minor injury to the testicles. In some cases, it can also happen while sleeping or after an injury to the scrotum. Sometimes, one may not know the cause of the twisting.

Rapid growth of testicles during puberty can also be a cause of testicular torsion.

In many cases of testicular torsion, the affected males also have another condition called bell clapper deformity. In most instances for males, the testicles are attached to the scrotum, thus making it hard for them to get twisted, whereas in those who suffer from bell clapper deformity, the testicles are not secured, which can result in movement and twisting in the scrotum.

Seek a Doctor

If an individual experiences sudden, severe pain in the scrotum, it is advised to call a doctor as soon as possible without wasting any time. Until you have met with a doctor for further treatment, do not eat or drink anything. Note that testicular torsion is an emergency and will require surgery. The longer the spermatic cord is in the twisted position, the lower the chances of saving the testicles. In some cases, the twisted spermatic cord untwists itself without any course of treatment. Such a situation is known as torsion and detorsion. In such cases, testicular torsion can reoccur. There have also been cases where the spermatic cord is untwisted and causes no pain after some time. In such cases, the individual might ignore the condition, but it is also advisable to call the doctor and disclose the condition. The doctor will check the condition and carry out further steps to ensure the testicular torsion is unlikely to come back in the future.

One may find it embarrassing to speak to someone about their private parts, but it is very important to at least talk to your parents or the doctor about what you feel or what symptoms you are experiencing. Ignorance of pain for a longer duration is not good, nor is simply thinking the pain will go away on its own. Ultimately, it can severely and permanently damage the testicles. Doctors can conduct a proper examination and carry out the desired test so that the risk of another torsion is reduced. This can be done by conducting simple surgical procedures, which would provide security to the testicle in the scrotum.

A doctor who specializes in urinary tract issues or disorders affecting the male genitals, called a urologist, would be able to examine you. Below are some of the ways to prepare for the appointment:

• Note down the list of symptoms being experienced, which would also include any unrelated signs as well.
• Ask the doctor why such things are happening. Some possible questions you can ask are:
  • Are there any other possible causes for the symptoms?
  • What are the complications concerning the surgery?
  • Are there any possible consequences of not doing the surgery?
  • Are there any restrictions on activities that will need to be followed after the surgery?
  • Will I be able to father any children?
  • How can I prevent a reoccurrence of this medical condition?

The doctor will ask a couple of questions to obtain a correct diagnosis. One should be ready to answer these questions and not feel ashamed of doing so. The doctor may ask the following questions:

• How severe are the symptoms?
• When did you first experience the symptoms?
• Has such a thing ever happened in the past?
• Is anyone in the family going through a similar situation, or had a similar situation in the past?
• Are the symptoms continuous or did they go away for some time?
• Have the symptoms worsened over time, or are they improving?
• What were you doing when you first experienced the symptoms?

Diagnosis of testicular torsion begins with a history of the illness and a physical examination of the scrotum, testicles, abdomen, and groin.

Reflexes are also tested by lightly rubbing or pinching the inside of the thigh on the affected side. Under normal circumstances, this causes the testicle to contract. If testicular torsion is present, this reflex might not occur.

Certain medical tests are necessary to confirm the diagnosis, including:

• Urine test: This is used to check for infection.
• Scrotal ultrasound: This type of ultrasound is used to check blood flow; decreased blood flow is a sign of testicular torsion.
• Surgery: Surgery may be performed to determine whether the symptoms are caused by testicular torsion or any other condition. Quick action is required to reduce the complication and save the affected testicle.

Surgery is the main treatment method for testicular torsion. The other option is manual detorsion, which is a procedure in which the doctor is able to untwist the testicle by pushing on the scrotum.

Surgery is required to prevent a relapse of testicular torsion. It is done under general anesthesia. The surgery does not require a stay in the hospital. To treat the torsion, the patient is taken to the operating room, and a painkiller is given along with general anesthesia. The patient is unconscious for the surgery. A small incision is made in the scrotum to untwist the spermatic cord and blood vessels surrounding it. The sooner the testicle is untwisted, the greater the chances of saving it. When it is done, the doctor will stitch the scrotum, and the patient is then taken to another room for recovery. Recovery occurs in an hour or two. The surgery itself, which involves attaching the testicles to the scrotum, usually takes around thirty to forty-five minutes. The patient will experience some pain, but it won’t be as bad as the pain of the torsion itself.

If treatment is done in less than six hours, the percentage of loss of the testicle is 5%. But if it is put off for more than forty-eight hours, it is difficult to save the testicle. In such cases, the affected testicle itself is removed through the help of surgery, called an orchiectomy.

Testicular torsion in newborns is rare, but when it does happen, the infant's testicle becomes hard, swollen, or darker in color. Surgery is required for testicular torsion in infants.

Treatment in infants is controversial because of the risks involved with general anesthesia, but emergency surgery can sometimes help save a part or all of the testicle.

Post-Surgery Precautions

Once the surgery is finished and the person is back home, they need to skip all strenuous activity, such as sports and sex. Masturbation should also be avoided for at least a few weeks after the surgery. It is best to speak to your doctor and understand when you can resume normal activities. Individuals who have their testicles removed are able to get artificial or prosthetic testicles attached after a few months post-removal. Individuals can still father children later in life with one working testicle. Prosthetic testicles can help some men feel more confident about their appearance. One should not feel depressed about the removal of the testicle; such individuals can still lead a normal life with their children. 

For people who have testicles that can rotate in the scrotum, the only way to prevent testicular torsion is to perform surgery to attach both testicles inside the scrotum.

There are no alternative or home remedies to treat testicular torsion.

The following are risk factors for testicular torsion:

• Age: Testicular torsion commonly occurs between the ages of twelve and sixteen.
• Previous testicular torsion: A previous case of testicular pain that resolved without any treatment increases the risk of having it again.
• Family history: Testicular torsion is a condition that runs in families. If not treated for several hours, blocked blood flow can cause permanent damage to the testicle, leading to damage and even the death of the testicle.
• Testicular damage: Testicles left untreated for several hours can lead to blockage of blood flow and possibly cause permanent damage to the testicle. Badly damaged testicles lead to the complete removal of the testicles.

In some cases, damage or loss of a testicle affects a man’s ability to produce sperm and leads to infertility.