Testicular Torsion

Testicular torsion is a serious medical condition that occurs when the spermatic cord, which carries blood to the testicles, becomes twisted. This twisting cuts off the blood supply to the testicle, leading to tissue damage and potentially resulting in the death of the testicle if not treated promptly.

Symptoms

• Sudden and severe pain in the testicle, which may radiate to the abdomen or groin area
• Swelling of the scrotum, which may become red, purple, or blue due to lack of blood flow
• Nausea and vomiting, which can occur as a result of the intense pain
• Fever, which may develop if the condition leads to infection
• Abnormal testicular position, where the affected testicle may be higher than its normal position or have a horizontal lie
• Loss of cremasteric reflex, which is the contraction of the muscle that runs from the internal oblique muscle to the spermatic cord, normally causing the testicle to rise when the skin of the upper inner thigh is stroked

Causes and Risk Factors

Testicular torsion can occur at any age but is most common in neonates and adolescents. The exact cause is often unknown, but several factors increase the risk:

• Anatomical abnormalities, such as a bell-clapper deformity where the testicle is not properly attached to the scrotum, allowing it to twist more easily
• Trauma to the testicles or groin area, which can cause the spermatic cord to twist
• Cold temperatures, which can cause the cremaster muscle to contract and potentially lead to torsion
• Sports injuries or any activity that involves sudden stops and starts, which may increase the risk of testicular torsion due to trauma

Treatments

Prompt medical attention is crucial for treating testicular torsion. The goal of treatment is to restore blood flow to the affected testicle as quickly as possible.

• Surgical intervention is usually necessary and involves untwisting the spermatic cord and fixing the testicle in place (orchiopexy) to prevent future episodes. This surgery should be performed within a few hours of symptom onset for the best outcomes.
• Manual detorsion may be attempted by a healthcare provider as an emergency measure before surgery, but this is not always successful and does not eliminate the need for surgical fixation to prevent recurrence.
• Pain management with analgesics may be provided to help manage discomfort until definitive treatment can be administered.
• Orchiectomy (removal of the testicle) may be necessary if the testicle is not viable due to prolonged lack of blood flow. This decision is typically made during surgical exploration based on the appearance and function of the testicle.

Prevention

While not all cases can be prevented, certain measures can reduce the risk:

• Avoiding activities that may cause trauma to the groin area when possible
• Wearing protective gear during sports and other high-risk activities
• Regular self-examinations to become familiar with normal testicular anatomy, which can help in identifying abnormalities early
• Seeking immediate medical attention if symptoms of testicular torsion occur

Complications

If left untreated or treated too late, testicular torsion can lead to:

• Infertility, as the affected testicle may not produce sperm after the event
• Testicular atrophy, where the testicle shrinks due to lack of blood supply and function
• Psychological impacts, including anxiety, depression, or body image issues related to the loss of a testicle or infertility concerns

Prognosis

The prognosis for testicular torsion is generally good if treated promptly. The sooner treatment is initiated, the higher the likelihood of saving the affected testicle and preserving its function.