What is Testicular Torsion? Testicular Torsion Symptoms

by Abbas Jahangir · June 22, 2024

Testicular torsion means that the testicles twist around the spermatic cord that nourishes them. The incidence of this condition is 1/4000. Testicular torsion can affect men of all ages, but is most common in newborns and adolescence. Surgical intervention is required as soon as possible for the treatment of testicular torsion.

What is Testicular Torsion?

The scrotum is a bag-like structure that contains the testicles. Nutrition of the scrotum is provided through the spermatic cord. The testicles rotate on the spermatic cord, causing the blood flow through the cord to decrease and sometimes even stop. The decrease in blood flow causes sudden, severe pain and swelling in the testicles.

Testicular torsion is a condition that requires urgent intervention. If the decrease in blood flow continues for a long time, the testicles become damaged and become unable to function. In order to save the testicles with minimal damage, the patient must undergo surgery as soon as torsion is detected.

What Causes Testicular Torsion?

Torsion; It means rotation, twisting. The torsion of the testicles on the spermatic cord, which provides nutrition to the scrotum, reduces the blood flow in the cord. If the testicles roll over the spermatic cord more than once, blood flow may stop completely. In this case, the testicle is damaged much more quickly.

The mechanisms that cause testicular torsion have not yet been fully elucidated. However, most men with testicular torsion have a deformity called ‘Bell clapper’. Bell clapper deformity allows the testicles to move easily within the scrotum. Normally, the testicles cannot move easily within the scrotum, thanks to the strong and supportive connective tissue around them. Increased mobility of the testicles in bell-clapper deformity increases the risk of torsion. However, there is no rule that every man with bell-clapper deformity will experience testicular torsion.

Bell clapper deformity is a genetic condition. The deformity often affects both testicles. Testicular rotation; It may occur a few hours after strenuous exercise, after a minor injury to the testicles, or during sleep. Rapid growth of the testicles during adolescence due to the effect of testosterone increases the possibility of torsion. Cold weather is another reason that increases the risk of torsion.

Testicular torsion is especially seen in men between the ages of 12-18. Men with a family history of testicular torsion are at risk for torsion. Testicles may detorse spontaneously in a short time after torsion. This torsion-detorsion condition may have occurred in men who felt sudden pain in their testicles, but whose pain disappeared without resorting to any treatment. This situation tends to recur. The more severe the person’s pain, the more severe the damage to the testicles usually occurs.

What are the Symptoms of Testicular Torsion?

Symptoms seen in testicular torsion:

Sudden onset of severe pain in the scrotum
Redness, swelling in the testicles
Stomach ache
Nausea, vomiting
Testicles in a different position than normal
frequent urination
It is in the form of fire.

Pain due to testicular torsion in young children can be severe enough to wake them up at night.

Men who experience severe pain in their scrotum should immediately contact the nearest health center. Testicular damage that may occur due to torsion can be prevented with early treatment. Men who experience severe testicular pain but whose pain goes away without treatment should also consult a doctor. This may be a torsion-detorsion condition in men. This may lead to testicular rotation that does not resolve spontaneously in the future. Therefore, men experiencing this problem may need surgery to prevent torsion.

If testicular torsion is not treated in a timely manner, serious complications may develop. These complications are as follows:

Testicular Damage: If testicular rotation is not intervened within a few hours, decreased blood flow may cause permanent damage to the testicle. A testicle that cannot be fed for a long time may die, and this testicle may need to be removed surgically.

Infertility: Testicular damage or loss can reduce a person’s reproductive capacity.

How is Testicular Torsion Surgery Performed?

To diagnose testicular torsion, the doctor first asks the patient what his complaints are. It tries to determine whether the symptoms seen in the patient are due to torsion or another cause. Afterwards, he examines the patient’s abdomen and groin area and examines his testicles. One of the diagnostic methods for testicular torsion is reflex examination. The doctor gently scratches the patient’s inner thigh on the affected side with a hard object. Under normal conditions, this causes the testicle to contract. However, this reflex may not occur in torsion patients. Some tests can be used to understand whether the patient’s symptoms occur due to torsion or another reason. These tests:

Urinalysis: A possible infection in the patient is checked with a urinalysis.

Scrotal Ultrasound: Blood flow to the testicle can be monitored with a method called Doppler ultrasound. Decreased blood flow to the testicles may be a sign of torsion. If the patient has severe scrotum pain lasting for several hours and the findings in the examination are compatible with testicular torsion, the patient can be operated on without additional tests. Because late intervention in testicular torsion can lead to serious consequences.

Surgery is needed to correct testicular torsion. Sometimes the doctor may detorse torsioned testicles manually using a method called the ‘opening and closing book’ method. However, in this case, the patient must undergo surgery to prevent torsion from recurring.

Testicular torsion surgery, also known as orchidopexy, is performed under general anesthesia. During the surgery, the surgeon makes a small incision in the scrotum and corrects the twisted spermatic cord. If necessary, one or both testicles of the patient are stitched into the scrotum. The sooner the testicle is repaired, the higher the chance of saving it. The risk of permanent damage to the testicle increases gradually in interventions performed 6 hours or later after the patient’s pain begins. If the intervention is delayed 12 hours or more after the pain begins, the patient’s testicle is seriously damaged and there is a 75% chance it will be removed.

Testicular torsion can also occur in newborn babies. The baby’s testicles may be hard, swollen and dark in color. Ultrasound is used to detect torsion. The treatment of torsion in babies is surgery. Deciding on testicular torsion surgery in babies can be difficult. If the baby is born with symptoms of torsion, it may be too late for intervention. There will also be risks associated with general anesthesia for surgery. However, sometimes taking the baby into surgery allows the testicle to be saved and torsion in the other testicle is prevented.

Correcting torsion with surgery can prevent the baby from having problems with issues such as reproductive hormone production and fertility in the future. Testicular torsion surgery in newborns is a decision that the doctor and family can make together. The doctor explains to the family all the advantages and disadvantages of the surgery. Afterwards, the decisions taken in line with the family’s wishes are implemented.

After testicular torsion surgery (orchiopexy), the patient is usually discharged on the same day. Patients whose testicles have been removed may need to stay in the hospital for a while. During the postoperative recovery period, there may be swelling in the scrotum that lasts for 2-4 weeks. Dissolvable material is generally used in stitches placed during surgery. Therefore, the patient does not need to have stitches removed. The patient can apply cold to his testicles for 10-20 minutes to reduce post-operative pain. The only way to prevent testicular torsion is to fix the testicles to the scrotum with stitches. However, this procedure is applied to people who have had torsion before and are experiencing torsion.

Testicular torsion is a health problem that requires urgent intervention. By detecting torsion early and starting the necessary treatment within the first few hours, the testicles can be saved with little damage. Delaying intervention for torsion may lead to loss of the testicle.