Introduction
Testicular torsion occurs when the tissues around the testis are loosely attached, which causes rotation of the testis. The spermatic cord is responsible for transporting blood to the scrotum, and testicular torsion causes the twisting of the spermatic cord to lose blood flow. It is common in younger age groups between twelve and eighteen. Testicular torsion can be seen in cases before birth and requires emergency treatment due to blood loss. In addition, there may be permanent damage to the testis, which may have to be surgically removed.
What Are the Symptoms of Testicular Torsion?
The symptoms include:
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Spontaneous and severe pain in the scrotum (sack present below the penis that holds the testis).
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Abdominal pain.
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Nausea and vomiting.
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Abnormal positioning of the testis.
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Swelling of the scrotum.
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Polyuria (frequent urination).
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Younger people often have severe pain in the scrotum that occurs early in the morning or in the middle of the night.
When to See a Doctor?
If the person experiences sudden or severe pain in the testicles, seek medical care immediately. Timely treatment may help save the testis from permanent damage. Immediate medical care should be taken for intermittent torsion and detorsion. Intermittent torsion and detorsion are cases in which the testicle twists and untwists itself. The person may experience sudden pain, which goes away without treatment. However, surgical intervention is required to prevent it from twisting again.
What Are the Causes of Testicular Torsion?
Testicular torsion occurs when the tissues around the testis are loosely attached, which causes rotation of the testis. The spermatic cord is responsible for transporting blood to the scrotum, and testicular torsion causes the twisting of the spermatic cord to lose blood flow. Repeated twisting may cause permanent loss of blood flow, and the testis may have to be surgically removed. Other causes involve vigorous activity, cold temperature, and rapid growth during puberty and sleeping.
Most of the cases are seen in the age groups below 25 years. Congenital abnormality of processus vaginalis is usually the cause. The onset is spontaneous, associated with trauma or exertional. Extravaginal torsion occurs in neonates because of the lack of adhesion of tunica vaginalis to the gubernaculum, due to which the spermatic cord is prone to distortion. This can happen before birth and has different treatment approaches. Intravaginal torsion occurs when the tunica vaginalis is high, and the spermatic cord gets twisted inside. This is also called the bell clapper deformity.
What Are the Risk Factors for Testicular Torsion?
The risk factors include:
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Age: It is more common in age groups between twelve to eighteen.
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Family History: This disease can be inherited.
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History of Testicular Torsion: Intermittent torsion and detorsion are conditions in which the testicle twists and untwists. The person with these conditions may experience sudden pain, which goes away without treatment. However, surgical intervention is required to prevent it from twisting again.
What Are the Complications of Testicular Torsion?
The complications involve:
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Permanent damage to the testis: Prolonged loss of blood flow to the testicles causes permanent damage to the testicles and may have to be surgically removed.
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Infertility (Inability to produce offspring).
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Cosmetic deformity.
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Loss or reduced exocrine and endocrine function in men.
What Is the Diagnosis of Testicular Torsion?
Diagnosis involves the physical examination of the scrotum, testicles, abdomen, and groin. They may check for testicular reflexes by pinching the inner thighs, which causes flinching of the testis. The reflex is absent in testicular torsion.
Other diagnostic tests involve:
Urine Test: Urine is checked for infection.
Scrotal Ultrasound: It helps detect decreased blood flow in the testicle, a sign of testicular torsion. It is the common diagnostic procedure used in testicular torsion and has sensitivity and specificity rates of 93 % and 100 %, respectively.
Surgery: It can be used to check for a differential diagnosis or detect any associated condition.
Twist Scoring System: This test is used to evaluate the extent of testicular torsion.
The twisting tool includes:
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Hard testis -2.
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Swelling -2.
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Nausea or vomiting -1.
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Cremastric reflex absent -1.
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High riding testes -1.
The individual with a higher score has a high probability of having testicular torsion. An ultrasound is performed to further evaluate the low scores, and individuals with the highest score can be directly advised for surgery.
Differential Diagnosis:
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Traumatic hematoma.
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Testis tumor.
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Orchitis.
Testicular Torsion in Infants and Newborns:
Testicular torsion is rare in newborns and infants. The symptoms involve hard, swollen, or darker color testes. Ultrasound is ineffective in diagnosing testicular torsion, so the doctor may opt for surgery.
What Is the Treatment for Testicular Torsion?
Surgical Modalities: 40 % of the neonatal testicles have no color flow doppler; hence ultrasound may not always be suggested. If the test scores are high, urologic surgery should be performed immediately, as the window of opportunity is six hours from the onset of pain. Beyond this, there may be necrosis and permanent loss of the testicle.
Manual Detorsion: This procedure is attempted if surgery is not an option. It is done by rotating the testis from the medial to the lateral direction in a 180-degree direction and then checking for pain. The testes are rotated in the opposite direction if the pain levels increase.
Treatment Modalities in Neonates: The scrotum is examined, and the common procedure performed is contralateral orchiopexy (a procedure of fixing the testes to the inner scrotal wall). This procedure helps in the prevention of future twisting. In addition, a testicular prosthesis is inserted after an orchiectomy (surgical removal of one or both testicles). It is inserted four to six months after the surgery.
Conclusion
Testicular torsion happens when the testis gets twisted around the spermatic cord, causing obstruction of blood flow and leading to pain and swelling. The symptoms include spontaneous and severe pain in the scrotum, abdominal pain, nausea and vomiting, and abnormal positioning of the testis. In addition, testicular torsion occurs when the tissues around the testis are loosely attached, which causes rotation of the testis. Diagnostic tests involve urine tests, scrotal examination, and ultrasound. Treatment modalities involve manual detorsion, surgical detorsion, and surgical removal of the testis.