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Testicular Torsion - An Overview

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Testicular torsion happens when the testis gets twisted around the spermatic cord, obstructing blood flow. Read the article below to know more.

Written by

Dr. Kavya

Published At October 12, 2022
Reviewed AtJanuary 10, 2023

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:

  • Spontaneous and severe pain in the scrotum (sack present below the penis that holds the testis).

  • Abdominal pain.

  • Nausea and vomiting.

  • Abnormal positioning of the testis.

  • Swelling of the scrotum.

  • Polyuria (frequent urination).

  • Fever.

  • 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:

  • Age: It is more common in age groups between twelve to eighteen.

  • Family History: This disease can be inherited.

  • 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:

  • 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.

  • Infertility (Inability to produce offspring).

  • Cosmetic deformity.

  • 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:

  • Hard testis -2.

  • Swelling -2.

  • Nausea or vomiting -1.

  • Cremastric reflex absent -1.

  • 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:

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.

Frequently Asked Questions

1.

How Does It Feel to Have Testicular Torsion?

Testicular torsion comes as a sudden and severe pain in the scrotal sac (the loose skin sack carrying the testicles). Men with torsion feel extreme discomfort, swelling, abdominal pain, and bouts of nausea and vomiting. The pain may be comparable to getting knocked or kicked hard on the balls.

2.

What Causes Testicular Torsion?

Testicular torsion may occur in at-risk men without any triggers from prolonged periods of standing, sleeping, exercising, or sitting. It may occur shortly after rigorous exercise or a minor injury to the testicles. Cold temperatures and rapidly growing testicles during puberty have also been seen as causative of testicular torsion.

3.

In Which Two Types Are Testicular Torsion Divided?

Testicular torsion can be divided into two distinct types based on the involvement of the tunica vaginalis. This is a serous membrane epoch covering the testicles. In case the membrane is highly fixated on the spermatic cord and allows it to be twisted within the membrane, the condition is called intravaginal torsion. If the entire spermatic cord and the tunica vaginalis get twisted, it is called extravaginal or perinatal torsion, as it usually occurs earlier in life.

4.

For How Long Can Testicular Torsion Be Left Untreated?

Testicular torsion is an emergent condition and requires urgent intervention within four to six hours. Intervention within this timeframe can save the testicle 90 percent of the time. Sometimes, torsion may develop gradually, with the pain progressively increasing over several hours to several days. If the condition is not treated within six hours, the person may lose one or both of the testicles.

5.

Is It Possible to Have Testicular Torsion During Sleep?

Prolonged sleep can cause testicular torsion when the testicle rotates several times around the spermatic cord. Improper sleeping position may be the reason for frequent torsion and detorsion. Sleeping position and excessively cold temperatures where the scrotum contracts rapidly for a prolonged time can cause testicular torsion.

6.

Is It Possible for Prolonged Sitting to Cause Testicular Pain?

Chronic testicular pain can worsen with sitting for a long time, lifting heavy objects, doing manual work, or even engaging in certain sports. Desk job people, truck drivers, manual laborers, and powerlifters may suffer from testicular pain due to various reasons ranging from infections to trauma.

7.

Is It Possible to Walk With Testicular Torsion?

Testicular torsion causes extreme pain and requires immediate interventions. It is extremely painful to walk and may even worsen the condition by further twisting the testicle around the spermatic cord.

8.

Does Testicular Torsion Continuously Cause Pain?

In the case of testicular torsion, the pain onsets suddenly and gradually increase. The condition requires immediate medical attention. The pain does not go away on its own, rather may progressively increase with time. Although requiring attention within six hours, the pain may wax and wane in cycles but may not completely go away.

9.

How to Self-Check for Testicular Torsion?

A TSE (testicular-self-exams) test can help a man identify any scrotal abnormalities. It is advisable for men to test themselves once every month. It is best to acquaint oneself with the feel, shape, and size of the testicles so as to recognize any changes at their budding stages.

10.

Who Is Susceptible to Testicular Torsion?

Testicular torsion is found commonly in males younger than 25, rarely in newborns, with an average of one patient per 4000 males. It is most commonly seen in males between the ages of 12 and 18. Risk factors involve underlying bell clapper deformity, undescended testicle, trauma, and prior intermittent torsion.

11.

What Is the Developmental Time Frame of Testicular Torsion?

In more than three-quarters of all cases of torsion, the condition develops rapidly within 12 hours. It has been reported to develop over several hours to days and often requires medical attention within the first six hours. It is possible to save the testicles within this period with a 90 percent probability.

12.

Is It Possible for Stress or Anxiety to Induce Testicular Torsion?

Stress or anxiety affects all parts of the body, including the nervous system and smooth muscles. In stressful situations, the nervous system may get overactive and make the smooth muscles around the testicles pull up, twist around the spermatic cord, or even retract within the abdomen.

13.

What Is the Reason for Pain in the Left Testicle?

Testicular pain in one or both of the testicles may be due to an acute injury, inflammation, STD (sexually transmitted disease), or due to testicular torsion. All the causes require immediate attention as they can lead to male infertility or even be fatal to the person. The pain might start from one testis and spread to the other.

14.

Is It Possible for Testicular Torsion to Heal on Its Own?

It is almost always a surgical intervention that is needed to fix the torsion abnormality. Rarely, the doctor might be able to palpate the testicle out of the loop by pushing the scrotum. Additionally, during sleeping, the testicle might undergo torsion and detorsion. Unfortunately, testicular torsion does not heal on its own and needs medical attention.
Source Article IclonSourcesSource Article Arrow
Dr. Samer Sameer Juma Ali Altawil
Dr. Samer Sameer Juma Ali Altawil

Urology

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