Testicular torsion represents a medical emergency involving the twisting of the structures that supply blood to the male gonad. This condition requires immediate medical attention to preserve the affected testicle.
Understanding Testicular Torsion
Testicular torsion occurs when the spermatic cord, which suspends the testicle within the scrotum, twists. This cord contains blood vessels, nerves, and the vas deferens. When the cord twists, it cuts off the blood supply to the testicle. Even a partial blockage can cause problems.
The twisting obstructs blood flow, depriving the testicle of oxygen. Without sufficient blood supply, the testicle tissue can die. This makes testicular torsion a time-sensitive condition, as prolonged lack of blood flow leads to irreversible damage.
Recognizing the Symptoms
Symptoms include sudden, severe scrotal pain, often on one side, which can be constant and may not subside. The affected testicle may become swollen and tender. Other symptoms can include abdominal pain, nausea, and vomiting. The affected testicle might appear higher in the scrotum than usual, or positioned at an unusual angle. Occasionally, there might be a visible lump or discoloration of the scrotal skin.
Causes and Risk Factors
Testicular torsion often results from a “bell clapper” deformity, where the testicle is not securely attached to the scrotal wall, allowing it to swing freely and twist. While it can happen at any age, it is most common in two age groups: newborns and adolescents (particularly between 12 and 18 years old). This condition can occur spontaneously, even during sleep, or after strenuous activity or a minor injury. However, physical activity itself is not considered a direct cause.
Diagnosis and Urgent Medical Attention
Diagnosis starts with a physical examination. The doctor assesses the scrotum, testicles, and groin for swelling, tenderness, or an elevated testicle. An absent cremasteric reflex (testicle contraction when the inner thigh is touched) can indicate torsion. A Doppler ultrasound is often used to assess blood flow and confirm the diagnosis; decreased or absent blood flow is a significant indicator. Due to the urgency, if physical examination strongly suggests torsion, immediate surgical exploration may be recommended without delay for further imaging.
Treatment and Recovery
Immediate surgical intervention is the primary treatment. During surgery, the surgeon makes an incision to access the twisted spermatic cord. The testicle is then untwisted, restoring blood flow. This is followed by orchiopexy, where the testicle is secured to the scrotal wall to prevent future twisting. The other testicle is also typically secured, as the predisposition often affects both sides.
Recovery involves managing pain and swelling with medication, rest, and ice packs. Patients are advised to avoid strenuous activity for several weeks for proper healing. The likelihood of saving the testicle depends on how quickly treatment is received; timely intervention, ideally within six hours of symptom onset, greatly improves the chances of preservation.