Testicular Torsion

Testicular torsion is a medical emergency.

• Testicular torsion is a surgical emergency that may result in the loss of the affected testicle if not treated promptly.
• This is a painful condition caused by the twisting of the spermatic cord, which causes a loss of blood flow to the testicle.
• Testicular tissue cannot survive without blood flow. Torsion is the most common cause of testicle loss in adolescent males.

The cause of the majority of cases is the bell clapper deformity, an anatomic abnormality that is present in some males. This anatomical condition allows the spermatic cord to twist more easily, resulting in compromise of the blood supply to the testicle. This can occur spontaneously or may be associated with trauma. There is no way to detect this deformity. In significant number of men who have this anatomical abnormality will have it in both testicles.

Testicular torsion is characterized by excruciating one-sided testicular pain, with sudden swelling. Since the cord structures twist (like the strings of a puppet), the testicle elevates as well. Patients may have nausea and vomiting. Patients may also have abdominal pain. There may be a history of previous testicular pain. Fever may also accompany the testicular pain.

Testicular torsion is seen most frequently in the 12-18-year-old age group, and most cases occur in men under 30 years of age. However, it can occur at any age, including newborns.

Testicular swelling and pain should be evaluated on an emergent basis. The evaluation is best done in an emergency room, where rapid imaging is available and there is quick access to surgical intervention.

• There is about a six-hour window for the testicle to be salvaged; surgical treatment within this time frame is associated with a 100% salvage rate for the testicle.
• After six hours, the salvage rate decreases, and if surgical repair is performed after 24 hours, the testicle is no longer salvageable.

You should notify your doctor immediately of your condition and ask where your doctor wants you to be evaluated. You may also ask your doctor to notify a urologist in the event surgery is needed.

The typical physical exam of the torsed testicle reveals a painful scrotum with one-sided testicular swelling and elevation. Lab tests may include a urinalysis and blood count. The scrotum may also be imaged by one or more radiologic studies.

Imaging may include a Doppler ultrasound of the testicles or a nuclear scan of the testicles to assess the degree of blood flow. Depending on the physical exam, and/or the time frame, imaging may not be done, since emergent treatment is essential to preserve the testicle.

The only treatment for testicular torsion is surgery. On rare occasions, a physician may be able to manually untwist the testicle, but this is not common. The importance of having testicular pain evaluated immediately cannot be overemphasized.

What Are the Home Remedies for Testicular Torsion?

Care at home is inappropriate and will only result in the loss of the testicle.

What Is the Medical Treatment for Testicular Torsion?

If your doctor suspects torsion, a urologist will be notified. Depending on your history and physical, you may either be brought to the operating room or you may have imaging done. Occasionally a testicular torsion may be manually detorsed (untwisted by hand) by a physician.

Medications

In the emergency room, the patient with testicular torsion will probably receive a narcotic such as morphine for pain relief.

The goal of surgery is to salvage the testicle. If the testicle cannot be salvaged, the testicle is removed (a procedure known as orchiectomy).

• If the testicle is detorsed successfully, it will be sutured within the scrotum so that it can no longer twist (called orchiopexy).
• The other testicle will also undergo the same fixation to the scrotum.

Patients who have a nonviable testicle may return for the insertion of a prosthetic testicle. This will be done only after the urologist feels that healing from the surgery is complete.

After surgery, the patient will learn if the testicle was able to be salvaged.

The surgeon will inform the patient as to when follow-up is needed.

The orchiopexy should prevent further episodes of torsion.

Fertility should be maintained even after the loss of one testicle. There will be no apparent changes noted physically beside the loss of the testicle.