Knowledge | Understanding Testicular Torsion: Symptoms, Diagnosis, and Treatment
Testicular torsion occurs when a testicle twists, also twisting the spermatic cord attached to it. The cord contains blood vessels that supply the testicle; torsion can reduce or stop blood flow, causing swelling and pain.
Testicular torsion is a medical emergency that requires prompt treatment to prevent infertility and other complications and to save the testicle.
Causes and Risk Factors
The testicles sit in the scrotum below the penis and are connected to the body by the spermatic cords. Normally, tissue anchors the testicles in place. Some males are born without this anchoring tissue, allowing a testicle to move freely in the scrotum; this is called a bell-clapper deformity. Newborns may develop torsion before the connecting tissue has formed.
Testicular torsion is rare, but risk is higher among those aged 12 to 16, although it can occur at any age; those who frequently perform strenuous exercise; those with a testicular injury or exposure to cold; during rapid testicular growth at puberty; and among those with a personal or family history of torsion.
Symptoms
When blood flow is cut off, torsion causes severe pain and swelling. Without prompt treatment, the testicle may die. Immediate medical care can prevent permanent damage. Seek care at once for any of the following:
Sudden, severe pain on one side of the scrotum
Redness and swelling of the scrotum
One testicle suddenly sitting higher than the other
Abdominal pain
Nausea or vomiting
Fever
Frequent urination
Dizziness
A lump in the scrotum
Blood in the semen
Diagnosis
Testicular torsion is often diagnosed in an emergency department. The doctor will ask about symptoms and examine the scrotum and testicles. The inner thigh on the affected side may be lightly stroked; normally this causes the testicle to contract or rise. No response may indicate torsion.
Tests may include:
Urinalysis to check for infection
Scrotal imaging, usually ultrasound, to assess blood flow to the testicle
Surgery may be needed to confirm testicular torsion
Treatment
A urologist treats testicular torsion. A doctor may sometimes untwist the testicle and cord manually, but most cases require surgery called orchiopexy. Under anesthesia, the surgeon makes a small incision in the scrotum, untwists the cord, and secures the testicle to the scrotum to prevent recurrence.
If the testicle is severely damaged, it will be removed in a procedure called orchiectomy.
Complications
Surgery within 6 hours after pain begins offers the best chance of saving the testicle. After 12 hours, blocked blood flow may cause permanent damage and surgical removal may be necessary, which can also reduce fertility.
Prevention
The only way to prevent torsion is surgery to secure the testicles in the scrotum, but this is performed only after torsion has occurred or while it is occurring, not as a routine preventive measure.
Outlook
After orchiopexy, rest and avoid activities that could injure the area. Do not ride a bicycle for at least one week or participate in sports for 4–6 weeks.
Knowledge | Understanding Testicular Torsion: Symptoms, Diagnosis, and Treatment
Knowledge | Understanding Testicular Torsion: Symptoms, Diagnosis, and Treatment
Testicular torsion occurs when a testicle twists, also twisting the spermatic cord attached to it. The cord contains blood vessels that supply the testicle; torsion can reduce or stop blood flow, causing swelling and pain.
Testicular torsion is a medical emergency that requires prompt treatment to prevent infertility and other complications and to save the testicle.
Causes and Risk Factors
The testicles sit in the scrotum below the penis and are connected to the body by the spermatic cords. Normally, tissue anchors the testicles in place. Some males are born without this anchoring tissue, allowing a testicle to move freely in the scrotum; this is called a bell-clapper deformity. Newborns may develop torsion before the connecting tissue has formed.
Testicular torsion is rare, but risk is higher among those aged 12 to 16, although it can occur at any age; those who frequently perform strenuous exercise; those with a testicular injury or exposure to cold; during rapid testicular growth at puberty; and among those with a personal or family history of torsion.
Symptoms
When blood flow is cut off, torsion causes severe pain and swelling. Without prompt treatment, the testicle may die. Immediate medical care can prevent permanent damage. Seek care at once for any of the following:
Sudden, severe pain on one side of the scrotum
Redness and swelling of the scrotum
One testicle suddenly sitting higher than the other
Abdominal pain
Nausea or vomiting
Fever
Frequent urination
Dizziness
A lump in the scrotum
Blood in the semen
Diagnosis
Testicular torsion is often diagnosed in an emergency department. The doctor will ask about symptoms and examine the scrotum and testicles. The inner thigh on the affected side may be lightly stroked; normally this causes the testicle to contract or rise. No response may indicate torsion.
Tests may include:
Urinalysis to check for infection
Scrotal imaging, usually ultrasound, to assess blood flow to the testicle
Surgery may be needed to confirm testicular torsion
Treatment
A urologist treats testicular torsion. A doctor may sometimes untwist the testicle and cord manually, but most cases require surgery called orchiopexy. Under anesthesia, the surgeon makes a small incision in the scrotum, untwists the cord, and secures the testicle to the scrotum to prevent recurrence.
If the testicle is severely damaged, it will be removed in a procedure called orchiectomy.
Complications
Surgery within 6 hours after pain begins offers the best chance of saving the testicle. After 12 hours, blocked blood flow may cause permanent damage and surgical removal may be necessary, which can also reduce fertility.
Prevention
The only way to prevent torsion is surgery to secure the testicles in the scrotum, but this is performed only after torsion has occurred or while it is occurring, not as a routine preventive measure.
Outlook
After orchiopexy, rest and avoid activities that could injure the area. Do not ride a bicycle for at least one week or participate in sports for 4–6 weeks.
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