Testicular Torsion

Definition

Testicular torsion is the rotation of a testicle. This rotation twists the cord, called the spermatic cord, which connects the testicle to the body. Blood vessels and nerves that are important to the testicles travel through this cord. A twisted cord can block the flow of blood to the testicle and damage the nerves. Without blood flow, the testicle tissue will begin to die. The nerve injury will cause pain.

Testicular torsion is a medical emergency that needs immediate treatment. Treatment should be started within 4-6 hours of the start of symptoms. Delayed treatment can lead to loss of the testicle.

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Causes

The testicles are normally kept stable by small sections of tissue that lightly connect the testicle to nearby areas. If the tissue is missing, torn, or placed too high, the testicle can turn too much. When the testicle turns, the cord becomes twisted.

Tissues that stabilize the testicles may be damaged by:

• Bell clapper deformity—A birth defect that is the most common cause of testicular torsion in which the testicular connections do not develop well.
• Trauma—It may damage connections and/or cause abnormal movement of the testicle.

In some cases, the exact cause may be unknown.

Risk Factors

Testicular torsion is most common in adolescent boys after puberty. Generally, the risk decreases after age 25.

Factors that may increase the chance of testicular torsion include:

• Family history of testicular torsion
• History of testicular abnormalities, such as an undescended testicle or a testicle with irregular orientation in the scrotum

Symptoms

A hallmark symptom of testicular torsion is sudden, intense pain in the testicle or scrotum. Most often the pain will be on one side, but it can occur on both sides. Other symptoms that may be present include:

• Nausea
• Vomiting
• Abdominal pain
• Swelling, redness, and/or warmth of the scrotum

Symptoms may appear during exercise, rest, or sleep.

In some cases, symptoms may suddenly stop without treatment. It is still important to see a medical professional to prevent it from happening again and to look for any permanent damage.

Diagnosis

The doctor will ask about your symptoms and medical history. A physical exam will be done. Testicular torsion may be diagnosed during a physical exam.

If the diagnosis is unclear the following tests may be done for other conditions that cause similar symptoms:

• Urine test—to look for urinary tract infections
• X-ray—to examine structures

Blood flow may be assessed with:

• Doppler ultrasound
• Nuclear imaging

Emergency treatment may need to be started right away, without testing. The diagnosis will be confirmed during surgery.

Treatment

Early treatment can help prevent complications. Testicular torsion is treated with emergency surgery. If surgery cannot be done right away, the doctor may attempt to untwist the spermatic cord by hand.

The goal of surgery is to restore blood flow, repair or remove any damaged tissue, and prevent further twisting. Surgical procedures include ONE of the following:

• Detorsion with orchiopexy—Untwisting the spermatic cord to restore blood flow. Each testicle is secured to the wall of the scrotum to prevent future twisting.
• Orchiectomy with orchiopexy—Removal of the affected testicle if there is too much damage. The remaining testicle will be secured to the wall of the scrotum.

Prevention

There are no current guidelines to prevent testicular torsion.