Testicular Torsion

Testicular torsion is a urological emergency that occurs when the spermatic cord, which supplies blood to the testicles, becomes twisted, cutting off the blood flow. If not treated promptly, this condition can lead to permanent damage or even loss of the affected testicle.

While the thought of such a condition may seem alarming, awareness and swift medical intervention can make a significant difference. This comprehensive blog explores everything you need to know about testicular torsion, from early symptoms to treatment options and prevention strategies.

What is Testicular Torsion?

Testicular torsion occurs when a testicle rotates, twisting the spermatic cord and cutting off its blood supply. This can happen suddenly and is most commonly seen in adolescent boys, although it can occur at any age, including infancy.

If blood flow is not restored within a few hours, the testicle can suffer irreversible damage, leading to infertility or the need for surgical removal.

Understanding the Anatomy

To understand testicular torsion, it helps to know a bit about the anatomy involved:

• Testicles (testes): Male reproductive glands located in the scrotum, responsible for producing sperm and testosterone.

• Spermatic cord: A bundle of fibers and tissues, including blood vessels, nerves, and the vas deferens, that connects the testicles to the abdominal cavity.

• Scrotum: The sac of skin that holds and protects the testicles.

In normal anatomy, the testicles are anchored within the scrotum in a way that limits excessive movement. However, in some individuals, especially those with a congenital condition known as the “bell clapper deformity”, the testicles are inadequately attached and can twist freely within the scrotum—putting them at risk for torsion.

Causes of Testicular Torsion

The exact cause of testicular torsion is not always known, but the following factors may contribute:

1. Bell Clapper Deformity

This congenital anomaly is the most common anatomical risk factor. It allows the testicle to rotate within the scrotum, making torsion more likely.

2. Trauma or Injury

Direct injury to the testicles can occasionally lead to torsion, although this is rare.

3. Sudden Movement or Activity

Physical activity or rapid movement during sleep may trigger torsion in predisposed individuals.

4. Cold Temperatures

Some studies suggest that exposure to cold weather can cause the cremasteric muscle to contract, increasing the risk of torsion.

5. Age and Hormonal Changes

Testicular torsion is most common between ages 12 and 18, possibly due to rapid growth and hormonal changes during puberty.

Symptoms of Testicular Torsion

Testicular torsion typically presents with sudden, severe pain in one testicle. Other common symptoms include:

• Swelling of the scrotum

• Redness or darkening of the scrotal skin

• Abdominal pain or nausea

• High-riding testicle

• Testicle that is at an unusual angle

• Frequent urination or urinary discomfort

• Vomiting (in some cases)

In infants and young boys, the signs might be more subtle, such as irritability, scrotal swelling, or refusal to eat.

⚠️ Important: Pain that disappears suddenly may indicate that the testicle has died and needs urgent removal. Do not ignore these symptoms.

When to Seek Immediate Medical Attention

Time is of the essence. If testicular torsion is suspected, seek emergency care immediately. Ideally, the testicle should be untwisted and blood flow restored within 4 to 6 hours to prevent permanent damage.

Delaying treatment for more than 12 hours significantly increases the risk of testicle loss.

Diagnosis of Testicular Torsion

A diagnosis is typically made based on a physical exam, medical history, and sometimes imaging tests. Here’s how the process usually unfolds:

1. Physical Examination

The doctor will inspect the scrotum, testicles, and abdomen for signs of swelling, tenderness, and abnormal positioning.

2. Scrotal Ultrasound

This imaging test uses sound waves to assess blood flow to the testicles. Reduced or absent flow indicates torsion.

3. Urine Test

To rule out infection, which can mimic symptoms of torsion.

4. Radionuclide Scan

Though rarely used, this nuclear scan shows blood flow to the testicles and can confirm torsion.

Treatment of Testicular Torsion

🔴 Emergency Surgery (Orchiopexy)

If torsion is confirmed, immediate surgery is required to untwist the spermatic cord and restore blood flow. The procedure is called orchiopexy.

• If the testicle is viable: It is untwisted and stitched to the scrotal wall to prevent future torsion.

• If the testicle is not viable (i.e., dead due to prolonged lack of blood): It is removed in a procedure called orchiectomy.

The opposite testicle is also often stitched in place to prevent torsion on that side in the future.

🟡 Manual Detorsion

In rare cases where surgery is not immediately available, a doctor may attempt to manually untwist the testicle. However, this is not a definitive solution and surgery is still needed later.

Recovery After Surgery

Recovery is usually quick and uncomplicated:

• Most patients can return to non-strenuous activities within a week.

• Avoid sports, heavy lifting, and sexual activity for about 4–6 weeks.

• Pain and swelling usually subside within a few days.

Post-operative complications are rare but may include infection, fluid buildup, or chronic discomfort.

Long-Term Outlook and Complications

If treated promptly, most individuals make a full recovery with no long-term effects on fertility or hormone levels.

However, delayed treatment can lead to serious complications:

• Loss of the testicle

• Reduced fertility

• Testicular atrophy (shrinkage)

• Psychological impact, especially in adolescents

Testicular Torsion vs. Other Conditions

It’s important to differentiate torsion from other causes of testicular pain:

Only a medical professional can confirm the diagnosis, which is why prompt evaluation is essential.

Prevention of Testicular Torsion

There is no guaranteed way to prevent torsion, but the following steps may help:

✔️ Early Detection

Teach adolescents to report any testicular pain immediately.

✔️ Preventive Surgery

If someone has had torsion on one side or is found to have a bell clapper deformity, doctors may recommend elective orchiopexy to prevent torsion.

✔️ Regular Self-Examination

Encourage monthly testicular self-exams to detect any lumps, changes, or asymmetry early.

Frequently Asked Questions (FAQs)

1. Can testicular torsion happen more than once?

Yes. If not surgically corrected, it can recur. This is why orchiopexy is recommended after the first episode.

2. Is fertility affected after torsion?

If only one testicle is removed and the other is healthy, fertility is usually preserved. However, severe or bilateral torsion may affect sperm production.

3. Is torsion painful even when the testicle is lost?

After the initial pain subsides, a dead testicle may not cause ongoing pain but poses risks of infection or abscess, which is why removal is necessary.

4. Can infants have torsion?

Yes. Neonatal torsion occurs before or shortly after birth. It often goes undetected until it’s too late to save the testicle.

Raising Awareness: The Role of Education

Institutions like Sparsh Diagnostic Centre play a crucial role in raising awareness about testicular torsion. Their clear and concise visuals—like the one comparing a normal testicle, a testicle at risk due to bell clapper deformity, and one affected by torsion—help in understanding this medical emergency effectively.

Such initiatives encourage prompt medical attention and promote early detection, ultimately saving lives and testicles.

Testicular torsion is a painful and time-sensitive emergency that can result in the loss of a testicle if not addressed quickly. Understanding the warning signs and seeking immediate medical care are crucial to preserving reproductive health and avoiding irreversible damage.

If you or someone you know experiences sudden testicular pain, don’t wait. Head to the emergency department or a trusted diagnostic centre like Sparsh Diagnostic Centre without delay.

Need Expert Help?

📍 Visit Sparsh Diagnostic Centre
📞 Call/WhatsApp: 9830117733 / 8335049501
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Let awareness be your first line of defense.

#BhaloTheko.

Disclaimer:

No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.