Testicular Torsion

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Testicular Torsion

Testicular torsion is a disorder in which the testicles rotate (twist) and strangle the spermatic cord, which consists of blood vessels, lymphatic vessels, nerves, and the duct that carries sperm from the body (vas deferens), cutting off the blood supply to the testicles. Torsion can cause shrinkage (atrophy) and tissue death (necrosis), and may require surgical removal of the testicles (orchiectomy) if not treated promptly. Torsion often occurs during sleep.

Incidence and Prevalence
Testicular torsion primarily affects infants in the first year of life and adolescent boys age 12-18, although it can occur at any age. Males with one or both testicles not descended into scrotum (cryptorchidism) develop testicular torsion more often than the general population.

Risk Factors

Injury to the scrotum or groin and vigorous physical activity are risk factors.

Causes

Injury to the scrotum can initiate a muscle spasm that cause the testicles to twist. Some cases result from inadequate connective tissue that "anchors" the testicle within the scrotum. Many cases are idiopathic (i.e., have no known cause).

Signs and Symptoms

Symptoms include the following:

• Blood in semen
• Lower abdominal pain
• Lump in testicle
• Nausea and vomiting
• Sudden, severe testicular pain, followed by diminishing pain after several hours (after necrosis begins to set in)
• Redness of scrotum
• Swelling of one testicle

Diagnosis

A patient history and physical examination is usually sufficient to diagnose testicular torsion. Testicular torsion may cause symptoms (e.g., testicular pain and swelling) similar to epididymitis (i.e., inflammation of the tubule where sperm is stored) and diagnostic tests may be necessary.

Color Doppler sonography (color printout of an ultrasound echo test) is used to identify the absence of blood flow typically found in a twisted testicle, which distinguishes the condition from epididymitis.

Urinalysis (analyzing chemical composition of urine) can be used to rule out bacterial infections.

Surgical exploration may be necessary if diagnosis cannot be made using other methods.

Treatment

Treatment involves untwisting (detorsion), manually if possible and surgically if necessary. Surgical detorsion requires anesthesia followed by an incision in the scrotum. The testicles are untwisted and evaluated for necrosis. Dead tissue is removed; removal of one or both testicles may be necessary. If necrosis has not occurred, the healthy testicle(s) are then sutured (stitched) to the scrotal wall to avoid recurrence.

Prognosis
If torsion is diagnosed and treated within 5-6 hours, the prognosis is good. The more time that elapses before resolution worsens the prognosis. After 18-24 hours, necrosis usually develops and indicates removal of the affected testicle (orchiectomy).

Urologic Emergencies, Torsion, Causes, Symptoms, Diagnosis, Treatment reprinted with permission from urologychannel.com
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