Understanding Testicular Torsion: Symptoms and Treatment

Testicular torsion is a medical emergency that occurs when the spermatic cord twists, cutting off the blood supply to the testicle. This condition is most common in adolescent males but can occur at any age. Immediate diagnosis and treatment are crucial to prevent severe complications, including loss of the testicle.

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Symptoms of Testicular Torsion

Recognizing the symptoms of testicular torsion can be life-saving. Here are the primary indicators:

Acute Scrotal Pain

The hallmark symptom of testicular torsion is sudden, severe pain in one testicle, which may radiate to the lower abdomen and groin.

Swelling and Redness

The affected testicle often becomes swollen, and the scrotum may appear red or darkened.

Nausea and Vomiting

Nausea and vomiting frequently accompany the acute pain, adding to the distress.

Abnormal Testicular Position

The affected testicle may lie higher than usual or at an unusual angle within the scrotum.

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Causes of Testicular Torsion

Understanding the causes of testicular torsion can provide insight into risk factors and prevention.

Intravaginal Torsion

Intravaginal torsion occurs when the testicle rotates within the tunica vaginalis. This condition is often linked to the "bell clapper deformity," where the testicle is inadequately secured, allowing it to twist.

Extravaginal Torsion

Extravaginal torsion generally occurs in neonates and involves the twisting of the spermatic cord outside the tunica vaginalis. This is less common but equally severe.

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Risk Factors for Testicular Torsion

Certain factors increase the risk of developing testicular torsion.

Age

Testicular torsion is most common between the ages of 12 and 18, peaking around puberty.

Family History

A family history of testicular torsion can elevate the risk, suggesting a genetic predisposition.

Previous Torsion

Individuals who have experienced testicular torsion are at a higher risk of recurrence, especially if corrective surgery is not performed.

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Diagnosis of Testicular Torsion

Prompt diagnosis is essential for effective treatment and to minimize complications.

Physical Examination

A thorough physical examination is the first step in diagnosing testicular torsion. The doctor will check for tenderness, swelling, and abnormal positioning of the testicle.

Ultrasound Imaging

Colour Doppler ultrasound is a key diagnostic tool, providing real-time images of blood flow to the testicle. A lack of blood flow indicates torsion.

Urinalysis

Urinalysis can help rule out infections such as epididymitis, which can present with similar symptoms.

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Testicular Torsion vs. Epididymitis

Differentiating testicular torsion from epididymitis is crucial due to the urgency of treatment.

Pain Onset

Testicular torsion pain is sudden and severe, whereas epididymitis pain usually develops gradually.

Fever

Fever is more common in epididymitis, while it is rare in testicular torsion.

Urinary Symptoms

Epididymitis is often accompanied by urinary symptoms such as dysuria or frequency, which are uncommon in testicular torsion.

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Emergency Management of Testicular Torsion

Immediate action is required to save the affected testicle.

Manual Detorsion

In some cases, a healthcare provider may attempt manual detorsion to untwist the spermatic cord. However, this is often only a temporary measure.

Surgical Intervention

Surgery is the definitive treatment for testicular torsion. The procedure, known as orchiopexy, involves untwisting the spermatic cord and securing the testicle to the scrotal wall to prevent recurrence.

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Surgical Procedures for Testicular Torsion

Orchiopexy

Orchiopexy is the standard surgical procedure for testicular torsion. It involves making an incision in the scrotum, untwisting the spermatic cord, and suturing the testicle to the scrotal wall. The contralateral testicle is usually secured as well to prevent future torsion.

Orchiectomy

If the testicle is nonviable due to prolonged ischemia, an orchiectomy (removal of the testicle) may be necessary.

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Treatment Options for Testicular Torsion

Immediate Surgery

Emergency surgery is the primary treatment for testicular torsion. Delaying surgery can result in irreversible testicular damage.

Pain Management

Postoperative pain management includes analgesics and anti-inflammatory medications to reduce discomfort and swelling.

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Complications of Testicular Torsion

Failure to promptly address testicular torsion can lead to serious complications.

Testicular Atrophy

Prolonged ischemia can result in testicular atrophy, where the testicle shrinks and loses function.

Infertility

Damage to the testicle can impair sperm production, potentially leading to infertility.

Infection

Necrosis of the testicle can cause infection, necessitating surgical removal.