Testicular Torsion: Symptoms, Causes & Diagnosis

What is Testicular Torsion?

This is a condition that occurs when a testicle rotates and loses blood flow. Because of reduced blood flow, an individual experiences a lot of swelling and pain. Testicular torsion requires immediate medical care and it should be treated within 6 hours to prevent permanent damage. If not treated, the testicle will be damaged and surgery will be required to remove it.

Who Can Get Testicular Torsion?

Testicular torsion is common in adolescent males and can happen at any age. According to Cleveland Clinic, this condition affects one in 4, 000 males under 25 years of age, but it is rare. This condition is most common in men aged between 12 to 18 years, accounting for up to 65% of all the cases.

What are the Causes of Testicular Torsion?

Testicles are two important organs that rest in the scrotum. They are supplied with enough blood by a cord called spermatic called. During a testicular torsion, the spermatic cord twists, affecting blood supply. Reduced blood flow causes the tissues in the testicle to die slowly.

It can happen during vigorous sex, while standing, exercising, sleeping, or when sitting. Besides, testicular torsion can be prompted by an injury or rapid growth during puberty.

Sometimes, this condition can be caused by a congenital trail called “bell clapper” deformity. If you have this congenital trail, the testicles move slowly in the scrotum. The free movement increases the chances of the spermatic cord becoming twisted. The “bell clapper” deformity is responsible for up to 90% of testicular torsion cases.

Moreover, this condition can run in families. So, knowing that it runs in the family will enable you to request immediate treatment if you notice the symptoms or someone in the family. In a recent study, approximately 10% of individuals with the condition have a family history of testicular torsion.

What are the Symptoms of Testicular Torsion?

The main sign of testicular torsion is pain and swelling on the scrotum caused by reduced blood flow. The swelling can be limited to one side, or in the entire scrotum. Other symptoms of testicular torsion include:

• Change in scrotum color, redness or darkening
• Abdominal pain
• One testis being larger than the other
• Frequent urination
• Nausea
• Vomiting
• Fever
• Blood in the semen
• Lumps in the scrotal sack
• Dizziness

This condition mostly occurs in one testicle, mostly on the left side. When both testes ate affected, it is called bilateral torsion, but it is extremely rare. Sometimes, an individual can experience intermittent torsion and detorsion. Intermitted torsion and detorsion is when you experience the pain that goes away without treatment. A testicle may twist and untwist itself without intervention.

However, even if the testicle untwists itself, you should seek medical help. Surgery can be done to prevent intermittent torsion from happening again.

How is Testicular Torsion Diagnosed?

Testicular torsion is a medical emergency that requires rapid diagnosis and treatment.

Your doctor will examine your testicles, scrotum, and groin. They will want to know more about your symptoms to know what is causing the signs; either testicular torsion or another condition.

Still, the doctor can lightly pinch or rub the inside of the thigh on the affected side to test your reflexes. The rub or pinch will lead to the contraction of the testicle. The reflex won’t occur if there is testicular torsion.

Medical tests can be done to confirm diagnosis or identify another condition. These tests include:

• A scrotal ultrasound—this test assesses blood flow. If you have decreased blood flow, this can be a sign of testicular torsion
• Blood or urine tests to check for infection
• Nuclear scan of the testicles to detect areas of reduced blood flow
• Imaging of the scrotum
• Physical exams
• If your pain has lasted for hours and the physical exam concludes its testicular torsion, surgery will be done to prevent loss of the testicle.

Are there Treatment Options for Testicular Torsion?

This condition requires emergency surgery that should be done with a lot of care. After the torsion, the testicle can be saved within 4-6 hours, but after 12 hours, permanent damage will occur. Sadly, permanent damage will cause infertility, erectile dysfunction, and low sex drive.

The treatment of testicular torsion involves the surgeon untwisting the spermatic cord to restore normal blood supply. Sometimes, manual detorsion is possible, but surgery is vital to prevent a recurrence. If you have a dead testicle, it must be removed to prevent a gangrenous infection. After a successful surgery, you have to avoid sexual activity or strenuous activity for weeks.

For newborns with testicular torsion, the testes can rarely be saved. Emergency treatment for adults is not the same for infants. Shortly after birth, the second side can twist, leading to sudden death of the testes. This will leave the baby with no testes. However, with good anesthesia, the infarcted testicle will be removed, and stitches can be used to prevent torsion in the other testis.

What are the Complications Associated with Testicular Torsion?

Testicular torsion is a condition that needs immediate treatment. If it is not treated within 6, or at all, it can cause severe complications including:

• Infertility will happen if damage occurs to both testicles. However, if you only lose one testicle, your fertility won’t be affected.
• It can cause a gangrene infection. Gangrene is a life-threatening infection that occurs when a dead or damaged testicle tissue is not removed. It spreads throughout the body, leading to shock.
• If testicular torsion is not treated, it leads to testicular atrophy, causing the testicle to shrink. With the condition, you won’t be able to produce sperm.
• Losing one testicle can create cosmetic deformity, causing emotional upset.
• It can lead to testicular death. If the twisted testicle is not treated within 4 to 6 hours, the testicle will be damaged severely. When damaged, surgery has to be done to remove the testicle. When left untreated for 12 hours, the chances of saving the testicle are 50%. After 24 hours, the chances of saving the testicle are 10%.

Outlook for People with Testicular Torsion

If you notice the symptoms early and it is treated immediately—mostly within six hours—the testicle can be saved. However, if the blood flow is cut for more than 6 hours, the testicle will lose blood supply and fail to function. So, seek immediate medical attention when you notice the symptoms.