What Is Testicular Torsion? What Causes Testicular Torsion?

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Main Category: Urology / Nephrology
Also Included In: Men's health
Article Date: 01 Jun 2010 - 0:00 PDT


Testicular torsion occurs when a testicle rotates on the spermatic cord, which provides blood flow to the testicle. As a result, the flow of blood is stopped causing sudden, often severe pain and swelling. Prolonged testicular torsion will result in the death of the testicle and surrounding tissues.

Generally, testicular torsion requires emergency surgery. If treated within a few hours, the testicle can usually be saved. However, waiting longer for treatment can cause permanent damage and may affect the ability to father children. When blood flow has been cut off for too long, a testicle may become so badly damaged it has to be removed.

Testicular torsion is most common in males 10 to 25 years old, but it can occur at any age. About 65 percent of cases occur in adolescents between 12 to 18 years of age. It occurs in about 1 of 4,000 males before the age of 25.

According to Medilexicon's medical dictionary:

Testicular Torsion is Torsion occurring during fetal development can lead to what is known as neonatal torsion or vanishing testis. This is one of the causes of an infant being born with one testicle (monorchism).

What are the signs and symptoms of testicular torsion?

A symptom is something the patient senses and describes, while a sign is something other people, such as the doctor notice. For example, drowsiness may be a symptom while dilated pupils may be a sign.

Signs and symptoms of testicular torsion include:

• Sudden or severe pain in one testicle
• Swelling of the scrotum, which is a loose bag of skin under the penis that contains the testicles
• Nausea
• Vomiting
• Abdominal pain
• A testicle can be positioned higher than normal or at an odd angle
• Tenderness of less than 6 hrs of duration
• Sudden testicle pain that goes away without treatment. This can occur when a testicle twists and then untwists on its own. This is known as intermittent torsion and detorsion.

Seek emergency care for sudden or severe testicle pain. Signs and symptoms may be caused by another condition. However, prompt treatment can prevent severe damage or loss of the testicle if it is testicular torsion.

If there is sudden testicle pain that goes away without treatment, seek prompt medical help. This occurs when a testicle twists and then untwists on its own (intermittent torsion and detorsion). Even though the testicle untwisted on its own, there is still need to see a doctor. Surgery may be required to prevent the problem from happening again.

What are the risk factors of testicular torsion?

A risk factor is something which increases the likelihood of developing a condition or disease. For example, obesity significantly raises the risk of developing diabetes type 2. Therefore, obesity is a risk factor for diabetes type 2.

• Age. Testicular torsion is most common in males between 10 and 25 years old.
• Previous testicular torsion. A person that had testicular torsion that went away without treatment is likely to have it again in either testicle unless surgery is performed to correct the underlying problem.
• Climate. Torsions are sometimes called "winter syndrome". This is because they often happen in winter, when it is cold outside. The scrotum of a man who has been lying in a warm bed is relaxed. When he arises, his scrotum is exposed to the colder room air. If the spermatic cord is twisted while the scrotum is loose, the sudden contraction that results from the abrupt temperature change can trap the testicle in that position. The result is a testicular torsion.
• Bell clapper deformity. In this deformity the testicle is only attached to the spermatic cord, like a bell clapper. A bell clapper deformity is a predisposing factor for testicular torsion in non-neonates. Currently there is no recommended clinical examination for a bell clapper deformity.

What are the causes of testicular torsion?

Testicular torsion occurs when the testicle rotates on the cord that runs upward from the testicle into the abdomen (spermatic cord). This rotation twists the spermatic cord and reduces blood flow. If the testicle rotates several times, blood flow to it can be entirely blocked, causing damage more quickly.

Males who get testicular torsion have an inherited trait that allows the testicle to rotate freely inside the scrotum. This inherited condition often affects both testicles.

In men and boys who are at risk of testicular torsion, the condition often occurs with no apparent trigger. Signs and symptoms of testicular torsion may start with the following:

• An injury to the scrotum
• Physical activity
• Sleep

What are the complications of testicular torsion?

The following complications can be caused by testicular torsion:

• Damage to or death of the testicle. When testicular torsion is not treated for several hours, blocked blood flow can cause permanent damage or death of the testicle. If the testicle is badly damaged, it has to be surgically removed.
• Inability to father children. In some cases, damage or loss of a testicle affects a man's ability to father children.

How is testicular torsion diagnosed?

Testicular torsion will likely occur as an emergency situation, leaving little time for the patient to prepare. During medical examination, a number of questions will be asked to verify whether the signs and symptoms are caused by testicular torsion or something else. The scrotum, testicles, abdomen and groin will be examined.

The doctor may also test the patient's reflexes by lightly rubbing or pinching the inside of the thigh on the affected side. Normally this causes the testicle to contract. This reflex probably will not occur if there is testicular torsion.

Dizziness and nausea are often present when there is an absence of blood supply to the testicle, as well as a tremendous amount of pain. If the diagnosis is questionable, a urologist should be consulted immediately, because testicular viability may be compromised.

Often, doctors diagnose testicular torsion with just a physical exam. Sometimes medical tests are necessary to confirm a diagnosis or to help identify another cause for the symptoms. These include:

• Urine tests or blood tests. This is to check whether the signs and symptoms are caused by an infection.
• Scrotal ultrasound. This uses high-frequency sound waves to create images of the testicle and check for blood flow. Decreased blood flow to the testicle is a sign of testicular torsion.
• Nuclear scan of the testicles. This involves injecting tiny amounts of radioactive material into the bloodstream. It is then possible to detect areas in the testicles that receive less blood flow, indicating torsion.
• Surgery. Sometimes surgery is necessary to identify whether symptoms are caused by testicular torsion or another condition. If there has been pain for several hours and the physical exam suggests testicular torsion, surgery may be performed without any additional testing. This is done in an attempt to save the testicle, because doing further testing might cause too much of a delay if there is no blood flowing to the testicle.

If suspicion is high, immediate untwisting is advised in order to prevent infarction and subsequent testicular loss with or without sterility.

If physical examination suggests a compromised blood supply and the patient has had such symptoms for a significant period, medical personnel may choose to bring the patient directly to surgery without an ultrasound, since the time required for ultrasound testing could affect testicular viability.

Surgical exploration may be necessary if diagnosis cannot be made using other methods. If there is the slightest hint of a torsion of the testicle, then doctors will perform surgery; even if the testicle turns out not to have twisted, they will still protect it by attaching the testicle to the scrotum wall.

What are the treatment options for testicular torsion?

Surgery is required to treat testicular torsion.

Manual detorsion: In some cases, the doctor may be able to untwist the testicle by pushing on the scrotum. However, surgery is still needed to prevent torsion from occurring again. If testicular torsion occurs before birth, surgery may not be possible.

Surgery for testicular torsion is usually done during general anesthesia. The surgery is uncomplicated and generally does not require a stay in the hospital. It is a simple and minimally invasive surgery.

During surgery, the doctor will:

• Make a cut in the scrotum which is a loose bag of skin under the penis that contains the testicles
• Untwist the spermatic cord, if necessary
• Stitch one or usually both testicles to the inside of the scrotum to prevent rotation

The surgeon may suture both testicles to prevent torsion from occurring on the other side. With prompt diagnosis and treatment the testicle can be saved in a high number of cases. Testicular torsion is a surgical emergency that needs immediate surgical intervention. The sooner the testicle is untwisted, the greater the chance of successful treatment:

• Within six hours, the testicle can be saved about 90 percent of the time
• After 12 hours, chances of saving the testicle fall to about 50 percent
• After 24 hours, the testicle can be saved only about 10 percent of the time. Once the testicle is dead it must be removed to prevent gangrenous infection.

After surgery, for several weeks, the patient needs to avoid:

• strenuous activity
• sexual activity

Testicular torsion in newborns and infants

In some cases, surgery is needed to diagnose and correct testicular torsion. This can prevent future problems with fertility or male hormone production. The doctor and parents decide whether a newborn or infant should have surgery.

After birth. If a boy is born with signs and symptoms of testicular torsion, it may be too late for emergency surgery to help. In some cases, the doctor may recommend later, nonemergency surgery.

Before birth. If signs and symptoms of testicular torsion occur after birth, the doctor may recommend emergency surgery.

Prevention

Having testicles that can rotate or move back and forth freely in the scrotum is an inherited trait. Some males have this attribute and others do not.
The only way to prevent testicular torsion for a man with this trait is through surgery to attach both testicles to the inside of the scrotum so that they cannot rotate freely.

Written by Stephanie Brunner (B.A.)
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today

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