Symptoms and treatment of Testicular torsion

Testicular torsion

Description

Testicular torsion occurs when a testicle rotates, twisting the spermatic cord that brings blood to the scrotum. The reduced blood flow causes sudden and often severe pain and swelling.

Testicular torsion is most common between the ages of 12 and 18 years, but can occur at any age, even before birth.

Testicular torsion usually requires emergency surgery. If treated quickly, the testicle can usually be saved. But when blood flow has been cut off for too long, a testicle could become so damaged that it has to be removed.

Symptoms

The signs and symptoms of testicular torsion include:

• A sudden, severe pain in the scrotum — the loose bag of skin under your penis that contains the testicles
• Swelling of the scrotum.
• Abdominal Pain
• Nausea and vomiting
• A testicle that is positioned higher than normal or at an unusual angle
• Frequent need to urinate
• Fever

Young boys who have testicular torsion typically wake up because of pain in the scrotum in the middle of the night or early in the morning.

When to see a doctor

Seek emergency care for sudden or severe pain in the testicles. Early treatment can prevent serious injury or the loss of your testicle if you have testicular torsion.

You should also seek prompt medical help if you have sudden pain in the testicles that goes away without treatment. This can occur when a testicle twists and then unroll it on your own (intermittent torsion and detorsion). The surgery is often necessary in order to prevent the problem from happening again.

Causes

Testicular torsion occurs when the testicle rotates on the spermatic cord that brings blood to the testicle in the abdomen. If the testicle rotates several times, the blood flow may be completely blocked, causing damage more quickly.

It is not clear why the testicular torsion occurs. Most of the men who have testicular torsion have an inherited trait that allows the testicle to rotate freely inside the scrotum. This inherited condition that often affects both testicles. But not all of males with the trait will have testicular torsion.

Testicular torsion often occurs several hours after vigorous activity, after a small injury to the testicles or while you sleep. The cold temperature or the rapid growth of the testes during puberty may also play a role.

Risk factors

• Age. Testicular torsion is most common between the ages of 12 and 18.
• Previous testicular torsion. If you've had testicular pain that went without treatment (intermittent torsion and detorsion), is likely to occur again. The most frequent attacks of pain, the greater the risk of testicular damage.
• The family history of testicular torsion. The condition can be hereditary.

Complications

Testicular torsion can cause the following complications:

• The injury or death of the testicle. When testicular torsion is not treated for several hours, blocking the flow of blood can cause permanent damage to the testicle. If the testicle is damaged, it has to be surgically removed.
• Inability to father children. In some cases, the damage or the loss of a testicle that affects the ability of a man to be the father of the children.

Prevention

Having the testicles, which can rotate in the scrotum is a trait inherited by some of the boys. If you have this feature, the only way to prevent testicular torsion is the surgery to attach both testicles within the scrotum.

Testicular torsion

Diagnosis

Your doctor will ask you questions to see if your signs and symptoms are caused by testicular torsion or something more. Doctors often diagnose testicular torsion with a physical exam of the scrotum, testicles, abdomen and groin.

Your doctor may also test your reflexes by rubbing or pinching the inside of your thigh on the affected side. Normally, this causes the testicle to contract. This reflection will not happen if you have testicular torsion.

Sometimes medical tests are necessary to confirm a diagnosis or to help you identify the cause of your symptoms. For example:

• Urine test. This test is used to verify the presence of infection.
• Ultrasound of the scrotum. This type of ultrasound is used to check the flow of blood. Decreased blood flow to the testicle is a sign of testicular torsion. But ultrasound does not always detect the reduction of the blood flow, so that the test does not rule out testicular torsion.
• Surgery. Surgery may be necessary to determine whether your symptoms are caused by testicular torsion, or another condition.

If you have been in pain for several hours and the physical examination suggest testicular torsion, can be taken directly to surgery without any additional testing. Delaying surgery may result in loss of the testicle.

Treatment

Surgery is required to correct testicular torsion. In some cases, the doctor may be able to untwist the testicle by pushing on the scrotum (manual detorsion). But you'll still need surgery to prevent torsion from occurring again.

Surgery for testicular torsion is usually done under general anesthesia. During the surgery, your doctor will make a small incision in the scrotum, untwist your spermatic cord, if necessary, and the stitch of one or both testes inside the scrotum.

The afternoon of the testicle and is untwisted, the greater is the probability that you can save. After six hours from the onset of pain, the chances of needing testicle removal are much higher. If the treatment is delayed more than 12 hours from the onset of pain, there is at least a 75 percent chance of the need for testicle removal.

Testicular torsion in neonates and infants

Testicular torsion can occur in neonates and infants, although it is rare. The baby of the testicle may be hard, swollen, or a darker color. The ultrasound does not detect a decrease in blood flow to the baby in the scrotum, so that the surgery can be needed to confirm the testicular torsion.

The treatment of testicular torsion in children is controversial. If a child is born with the signs and symptoms of testicular torsion, it may be too late for an emergency surgery to help and there are risks associated with general anesthesia. But an emergency surgery can sometimes save the whole or part of the testicles, and can prevent the torque in the other testicle. The treatment of testicular torsion in infants may prevent future problems with male hormone production and fertility.

Preparing for your appointment

Testicular torsion is an emergency, leaving very little time to prepare. Probably the first to be seen in the emergency room or your family doctor. However, it is likely to be seen by a doctor who specializes in problems of the urinary tract and disorders that affect the male genitalia (urologist).

If you have some warning before you see the urologist, here's some information to help you prepare, and what to expect from your doctor.

What you can do

• Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you are seeking treatment.
• Write down questions to ask your doctor.

Do not hesitate to ask questions during your appointment. Some questions to ask your doctor include:

• Why is this happening?
• There are other possible causes of the symptoms?
• What happens if I don't have the surgery?
• What are the possible complications of the surgery?
• Are there any restrictions on the activity that I'm going to have to follow after the surgery?
• How long after surgery will I have to wait to have an active sex life?
• I'm going to be able to father children?
• How can I prevent this from happening again?

What to expect from your doctor

Your doctor may ask you a series of questions. Be prepared to respond to them can give you more time to go through your concerns. You can ask:

• When did you first begin experiencing symptoms?
• What were you doing when he began to experience symptoms?
• The symptoms been continuous, or made to go away for a time?
• How severe are the symptoms?
• Nothing seems to improve or worsen your symptoms?
• Anyone in your family ever had testicular torsion?
• Has this ever happened before?