Overview
Testicular torsion is a condition where a testicle rotates on the spermatic cord, leading to a twisting of the blood vessels that supply the testicle. This results in sudden and severe pain, swelling, and potential damage to the testicle. It typically requires emergency surgery for proper treatment. It is most common among adolescents, and a family history of the condition may increase the risk.
Understanding the disease
Symptoms
The symptoms of testicular torsion include sudden, severe pain in the scrotum, swelling of the scrotum, abdominal pain, nausea and vomiting, a testicle that's positioned higher than normal or at an unusual angle, frequent urination, and fever. Testicular torsion typically requires emergency surgery and can cause damage or loss of the testicle if not treated promptly. Symptoms usually occur in the middle of the night or early in the morning.
Risk Factors
The risk factors for developing testicular torsion include:
- Age: Testicular torsion is most common between ages 12 and 18.
- Previous testicular torsion: If you've had testicular pain that went away without treatment (intermittent torsion and detorsion), it's likely to occur again. The more frequent the bouts of pain, the higher the risk of testicular damage.
- Family history of testicular torsion: The condition can run in families.
- Undescended testicle: An undescended testicle that doesn't move down into the scrotum before birth or in the months afterward can increase the risk of a scrotal mass and testicular torsion.
- Conditions present at birth: Some people are born with irregular changes in the testicles, penis, or kidneys, which may raise the risk of a scrotal mass and testicular cancer later in life.
- Vigorous activity, minor injury, or sleeping: Testicular torsion often occurs several hours after these activities, suggesting that they may be contributing factors.
- Cold temperature or rapid growth of the testicle during puberty: These factors may also play a role in the development of testicular torsion. Remember that prompt medical attention is crucial if you experience sudden or severe testicle pain, as testicular torsion requires emergency surgery to prevent severe damage or loss of the testicle.
Development
Testicular torsion occurs when a testicle rotates on the spermatic cord, which brings blood to the testicle from the abdomen. If the testicle rotates several times, blood flow to it can be entirely blocked, causing damage more quickly. The exact cause of testicular torsion is not clear, but it is believed to be related to an inherited trait that allows the testicle to rotate freely inside the scrotum. Testicular torsion is most common between ages 12 and 18, but it can occur at any age, even before birth. It often occurs several hours after vigorous activity, after a minor injury to the testicles, or while sleeping. Cold temperature or rapid growth of the testicle during puberty may also play a role. In some cases, testicular torsion can be a complication of previous testicular torsion or a family history of testicular torsion. If left untreated, it can lead to damage to or death of the testicle, and in some cases, inability to father children. Prevention of testicular torsion in individuals with the inherited trait involves surgery to attach both testicles to the inside of the scrotum. However, this surgery may not be necessary if the testicular torsion is mild and the testicle returns to its normal position on its own (intermittent torsion and detorsion).
Assessment and Diagnosis
Triage
If you experience sudden or severe testicle pain, it's important to seek emergency care. This is especially true if the pain is accompanied by swelling, abdominal pain, nausea, vomiting, fever, or a testicle positioned higher than normal or at an unusual angle. Prompt treatment can help prevent severe damage or loss of the testicle. If you have had sudden testicle pain that goes away without treatment, it's important to seek prompt medical help as well, as surgery may be needed to prevent the problem from happening again.
Diagnosis
To diagnose testicular torsion, your doctor will typically start with a physical exam of the scrotum, testicles, abdomen, and groin. They might also perform a reflex test by gently rubbing or pinching the inside of your thigh on the affected side. This reflex should cause the testicle to contract, but in cases of testicular torsion, it might not occur. In some cases, medical tests may be necessary to confirm the diagnosis or rule out other causes of symptoms. These tests may include:
- Urine test: This test checks for infection.
- Scrotal ultrasound: This imaging test uses sound waves to create pictures of your testicles and can help check blood flow. Decreased blood flow to the testicle is a sign of testicular torsion, but ultrasound doesn't always detect the reduced blood flow, so the test might not rule out testicular torsion.
Management and Treatment
Complications
Potential complications of testicular torsion include damage to or death of the testicle, inability to father children, and frequent recurrences of testicular torsion.
Home Remedies
In cases of testicular torsion, it is important to seek prompt medical help for proper diagnosis and treatment. Home remedies cannot replace medical attention, and it is essential to follow the advice of a healthcare professional in cases like this.
Treatment
Testicular torsion requires prompt medical attention and typically requires surgery to correct. The surgery, called an orchiectomy, involves detaching the testicle from the affected spermatic cord to restore blood flow. In some cases, the affected testicle may be salvaged, while in others, it may be necessary to remove the testicle completely. Emergency surgery is crucial to prevent further complications, such as damage to the testicle or loss of fertility. If you experience sudden and severe testicle pain, it is essential to seek emergency care as soon as possible. It's important to note that testicular torsion can recur in some individuals, even after having undergone surgery. In such cases, your healthcare provider may recommend a preventive procedure called an orchiopexy, which attaches the testicle to the scrotal wall to prevent further rotation and torsion.
Preparing for medical consultation
To prepare for an appointment for testicular torsion, you should:
- Be aware of any pre-appointment restrictions, and ask your healthcare provider about any necessary preparations at the time of scheduling your appointment.
- Write down any symptoms you're experiencing, including those that may seem unrelated to the reason for your appointment.
- Record key personal information, such as any other medical conditions, major stresses, or recent life changes.
- Find out if you have a family history of fertility problems or other reproductive issues.
- Inquire about any issues with your testicles or reproductive system from your parents, such as undescended testicles or other problems at birth or in early childhood.
- If you've experienced pain for several hours and your physical exam suggests testicular torsion, be prepared for the possibility of being taken directly to surgery without additional testing. Remember that testicular torsion is a medical emergency, and you might not have much time to prepare. Seek immediate medical attention if you suspect you have testicular torsion.