Testicular Torsion: A Twist That Can Be Painful

Testicular torsion meaning: What is it?

Testicular torsion occurs when a testicle rotates, twisting the spermatic cord thus cutting off the blood supply to the testicle. The reduced blood flow causes sudden and severe pain and swelling. Testicular torsion is most common among young men between the age of 12 to 18, however, it can occur at any age. Testicular torsion is a urological emergency and may require emergency surgery. If treated in time, the testicle can usually be saved. If the blood flow has been cut off for too long, the testicle might become so badly damaged that it has to be removed.

Testicular torsion symptoms and signs

Testicular torsion may present with the following signs and symptoms:

• Sudden, severe pain in the scrotum (scrotum: the loose bag of skin underneath the penis that contains the testicles)
• Redness and swelling of the scrotum
• Abdominal pain 
• Nausea and vomiting
• A testicle that’s positioned higher than normal or at an unusual angle

Testicular torsion causes

Testicular torsion occurs when the spermatic cord that connects each testicle to the rest of the body becomes twisted, cutting off the blood flow to the attached testicle. In most males, the testicles are attached to the scrotum, making it hard for the testicles to twist. However, some males are born with no tissue holding the testes to the scrotum, this then lets the testes “swing” inside the scrotum (known as a “bell clapper” deformity), making it more prone to twisting. 

Testicular torsion can also happen after strenuous exercise, or after a minor injury to the scrotum. However, most of the time there isn’t an apparent cause.

Testicular torsion risk factors

Testicular torsion is more likely to happen with the following risk factors:

• Personal history of testicular torsion
• Family history of testicular torsion 
• Between the ages of 12 and 18  - although it can happen at any age 

Testicular torsion diagnosis

Testicular torsion is often diagnosed with a physical examination by a doctor. Your doctor may also perform other diagnostic tests to help identify another cause of your symptoms. For example:

• Urine test  - check for urinary tract infection 
• Scrotal ultrasound - it can be used to check the blood flow to the testicle. However, it doesn’t always detect the reduced blood flow, therefore a negative ultrasound test result might not rule out testicular torsion

If your physical examination suggests testicular torsion, you might be taken directly to surgery without any additional testing, to avoid any delay in surgery which may result in loss of the testicle.

Testicular torsion treatment

Testicular torsion is an emergency. If the blood supply to the testicle is cut off for more than about six hours, permanent damage is likely to occur. Therefore an emergency exploration of the scrotum is usually required as a diagnostic, as well as therapeutic measure. 

During the surgery, a small cut will be made in the skin of the scrotum to expose the testicle. If testicular torsion is confirmed, the affected testicle is untwisted along the spermatic cord. The testicle is then stitched to the surrounding tissue and fixed in a position to prevent torsion from happening again. Due to an increased risk of torsion to the other testicle, fixation is usually done on both sides. 

Testicular torsion complications

Ideally, the operation should be done as soon as possible to maximize the chance of testicular salvage. In some occasions, although the testicle might be deemed salvageable during scrotal exploration, the extent of irreversible damage might lead to shrinkage of the testicle over the course of time. In unusual cases where the diagnosis was delayed or when the operation was done too late, the unreservedly damaged testicle may need to be removed. 

Although only one testicle is needed to produce normal amounts of sperm and testosterone, some studies have shown that up to a third of patients who had testicular torsion have a low sperm count. In addition to a reduction of sperm count, fertility might also be affected by the formation of anti-sperm antibodies. Most observational studies, however, revealed a fertility rate similar to that of the normal population. 

Sources

https://patient.info/

https://www.mayoclinic.org/

https://kidshealth.org/