Testicular torsion is a medical emergency which involves twisting of the testicles and the spermatic cord. The torsion causes decreased blood flow to the testes, depriving them of oxygen and nutrients. This is a painful problem that usually occurs in boys aged 10 and older. Testicular torsion usually requires immediate surgery to save the testicle. In this article, we'll examine more on this condition, including testicular torsion symptoms.
Testicular torsion symptoms and treatment: Expert opinion
The scrotum is the sack of skin beneath the penis. Inside the scrotum are two testes (plural of testis), also called testicles. The testicle is a male reproductive gland which helps to produce sperm and testosterone.
Each testicle is connected to the rest of the body by a blood vessel called the spermatic cord. Testicular torsion happens when a spermatic cord becomes twisted, cutting off the flow of blood to the attached testicle.
Under normal circumstances, testicles are attached to the scrotum, and are fixed in place. Some males are born with no attachments holding the testes to the scrotum, causing the testicle to rotate freely in the scrotum - this is known as the bell clapper deformity, and is a genetic condition.
The moving testicle will then twist the spermatic cord which brings blood to the testis, cutting blood supply and causing immense pain. Other common symptoms include fever, swelling of the scrotum, abdominal pain, and nausea.
Dr Ronny Tan, urologist at Mount Elizabeth Hospital & Parkway East Hospital, tells us more about testicular torsion symptoms and treatment options.
Testicular torsion – what it is and the risk factors associated with it
"Testicular torsion is a urological emergency.
"This happens when the spermatic cord, which contains the blood vessels that keep the testis alive, is twisted hence resulting in decreased blood supply to the testis.
"This results in sudden onset of testicular pain and if this condition is not treated, the affected testis can die.
"Males with a bell-clapper deformity are more prone to testicular torsion.
"In males with bell-clapper deformity, there is failure of normal posterior anchoring of the gubernaculum, epididymis and testis hence leaving the testis free to swing and rotate within the tunica vaginalis (layer of tissue that covers the testis and the spermatic cord) of the scrotum, much like the clapper inside of a bell. (Refer to picture above)
How to recognize testicular torsion symptoms
- Sudden onset of pain in the testis with swelling, associated with nausea
- The affected testis feels higher than it normally hangs in the scrotum and is tender to touch
- The testis is still painful even if one tries to cradle it and lift it up. (Prehn's sign)
How common is testicular torsion?
"Testicular torsion if left untreated will result in testicular loss as the affected testis will die due to lack of blood circulation. There is a window of 6 hours from the onset of torsion for salvage of the situation to save the affected testis.
"Testicular torsion is more common in males younger than 30 years, with most aged 12-18 years. Peak incidence occurs at age 13-14 years. Having said that, torsion can occur at any age. The impact of testicular torsion would be even greater in prepubescent boys since puberty and fertility would both be affected in this group."
Causes and treatment for testicular torsion
"Testicular torsion can occur under any circumstance. Trauma to the testis can result in torsion. Some patients present after vigorous activity and some present upon waking up from sleep.
"Males with bell-clapper deformity are more prone to torsion due to the way the testis is hanging from the spermatic cord.
"Treatment for testicular torsion would be surgical exploration.
"During the procedure in the operating room, the testis is de-torted (ie untwisted) in an attempt to re-perfuse the testis (ie to allow for blood to return to the testis) and to assess if the testis is viable or alive.
"If the testis is dead or non-viable, it will be removed surgically (orchidectomy). The testis on the other side will be fixed to the overlying muscle (known as the dartos) to prevent this testis from undergoing torsion.
"If the testis is deemed to be viable, BOTH testes will be fixed individually on each side to prevent torsion from occurring again.
"The most important message is, if there is a sudden onset of severe pain in the testis, see a urologist immediately."
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