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Testicular torsion
By Mayo Clinic staffOriginal Article: http://www.mayoclinic.com/health/testicular-torsion/DS01039
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Definition
Testicular torsion occurs when a testicle rotates on the spermatic cord, which provides blood flow to the testicle. This rotation cuts off the flow of blood and causes sudden, often severe pain and swelling. Testicular torsion is most common in males 10 to 25 years old, but it can occur at any age.
Testicular torsion generally requires emergency surgery. If testicular torsion is treated within a few hours, the testicle can usually be saved. But waiting longer to treat testicular torsion can cause permanent damage and may affect the ability to father children. When blood flow has been cut off for too long, a testicle may become so badly damaged it has to be removed.
Symptoms
Signs and symptoms of testicular torsion include:
- Sudden or severe pain in one testicle
- Swelling of the scrotum — a loose bag of skin under your penis that contains your testicles
- Nausea and vomiting
- Abdominal pain
- A testicle that's positioned higher than normal or at an odd angle
- Sudden testicle pain that goes away without treatment — this can occur when a testicle twists and then untwists on its own (intermittent torsion and detorsion)
When to see a doctor
Seek emergency care for sudden or severe testicle pain. While your signs and symptoms may be caused by another condition, if you do have testicular torsion, prompt treatment can prevent severe damage or loss of your testicle.
You also need to seek prompt medical help if you've had sudden testicle pain that went away without treatment. This occurs when a testicle twists and then untwists on its own (intermittent torsion and detorsion). Even though the testicle untwisted on its own, you still need to see a doctor because surgery is needed to prevent the problem from happening again.
Causes
Testicular torsion occurs when the testicle rotates on the cord that runs upward from the testicle into the abdomen (spermatic cord). This rotation twists the spermatic cord and reduces blood flow. If the testicle rotates several times, blood flow to it can be entirely blocked, causing damage more quickly.
Males who get testicular torsion have an inherited trait that allows the testicle to rotate freely inside the scrotum. This inherited condition often affects both testicles.
In men and boys who are at risk of testicular torsion, the condition often occurs with no apparent trigger. Signs and symptoms of testicular torsion may start following:
- Physical activity
- An injury to the scrotum
- Sleep
Risk factors
- Age. Testicular torsion is most common in males between 10 and 25 years old.
- Previous testicular torsion. If you've had testicular torsion that went away without treatment, it's likely to occur again in either testicle unless you have surgery to correct the underlying problem.
Complications
Testicular torsion can cause the following complications:
- Damage to or death of the testicle. When testicular torsion is not treated for several hours, blocked blood flow can cause permanent damage or death of the testicle. If the testicle is badly damaged, it has to be surgically removed.
- Inability to father children. In some cases, damage or loss of a testicle affects a man's ability to father children.
Preparing for your appointment
Testicular torsion will likely occur as an emergency situation, leaving you little time to prepare. You'll probably first be seen in the emergency room, or by your family doctor. However, you'll probably then be seen by a doctor who specializes in urinary tract problems and disorders affecting male genitals (urologist).
If you have some advance 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 why you're seeking treatment.
- Write down questions to ask your doctor.
Making a list of questions can help you ensure that you cover everything you want to. For testicular torsion, some basic questions to ask your doctor include:
- Why did this happen?
- Are there other possible causes for my symptoms?
- What kinds of tests do I need?
- Is surgery the only treatment?
- What happens if I don't have surgery?
- What are the possible complications of surgery?
- Are there any restrictions on activity that I'll need to follow after surgery?
- How long will I have to wait to be sexually active?
- Will I be able to father children?
- How can I prevent this from happening again?
In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions anytime you don't understand something.
What to expect from your doctor
Your doctor is likely to ask you a number of questions, such as:
- When did you first begin experiencing symptoms?
- What were you doing when you first started experiencing symptoms?
- Have your symptoms been continuous, or did they go away for a time?
- How severe are your symptoms?
- Does anything seem to improve or worsen your symptoms?
- Has anyone in your family ever had a testicular torsion?
- Has this ever happened to you before?
Tests and diagnosis
Your doctor will ask you a number of questions to verify whether your signs and symptoms are caused by testicular torsion or something else. He or she will also examine your scrotum, testicles, abdomen and groin.
Your doctor may also test your reflexes by lightly rubbing or pinching the inside of your thigh on the affected side. Normally this causes the testicle to contract. This reflex probably won't occur if you have testicular torsion.
Doctors often diagnose testicular torsion with just a physical exam. Sometimes medical tests are necessary to confirm a diagnosis or to help identify another cause for your symptoms. These include:
- Urine tests or blood tests, to see whether your signs and symptoms are caused by an infection.
- Scrotal ultrasound, which uses high-frequency sound waves to create images of your testicle and check for blood flow. Decreased blood flow to the testicle is a sign of testicular torsion.
- Nuclear scan of the testicles, which involves injecting tiny amounts of radioactive material into your bloodstream. Special cameras then can detect areas in your testicles that receive less blood flow, indicating torsion.
- Surgery. Sometimes surgery is necessary to identify whether symptoms are caused by testicular torsion or another condition. If you've had pain for several hours and your physical exam suggests testicular torsion, you may be taken directly to surgery without any additional testing. This is done in an attempt to save the testicle, because doing further testing might cause too much of a delay if there's no blood flowing to your testicle.
Treatments and drugs
Surgery is required to treat 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. If testicular torsion occurs before birth, surgery may not be possible.
Surgery for testicular torsion is usually done during general anesthesia, which means you won't be conscious. The surgery is straightforward and generally doesn't require a stay in the hospital. During surgery, your doctor will:
- Make a cut in your scrotum — a loose bag of skin under your penis that contains your testicles
- Untwist your spermatic cord, if necessary
- Stitch one or usually both testicles to the inside of the scrotum to prevent rotation
The sooner the testicle is untwisted, the greater the chance of successful treatment:
- Within six hours, the testicle can be saved about 90 percent of the time
- After 12 hours, chances of saving the testicle fall to about 50 percent
- After 24 hours, the testicle can be saved only about 10 percent of the time
After surgery, you'll need to avoid strenuous activity, including sexual activity, for several weeks. Ask your doctor when it's OK to resume normal activities, including sex.
Testicular torsion in newborns and infants
In some cases, surgery is needed to diagnose and correct testicular torsion. This can prevent future issues with fertility or male hormone production. Deciding whether a newborn or infant should have surgery depends on the judgment of the doctor, and in some cases, the desires of the parent.
- After birth. If a boy is born with signs and symptoms of testicular torsion, it may be too late for emergency surgery to help. In some cases, the doctor may recommend a later, nonemergency surgery.
- Before birth. If signs and symptoms of testicular torsion occur after birth, the doctor may recommend emergency surgery.
Prevention
Having testicles that can rotate or swing freely in the scrotum is an inherited trait, which some males have and others don't. The only way to prevent testicular torsion if you have this trait is through surgery to attach both testicles to the inside of the scrotum so that they can't rotate freely.
- Tiemstra JD. Evaluation of scrotal masses. American Family Physician. 2008;78:1165.
- Leslie JA, et al. Pediatric urologic emergencies and urgencies. Pediatric Clinics of North America. 2006;53:513.
- Schneck FX, et al. Abnormalities of the testes and scrotum and their surgical management. In: Wein AJ, et al. Campbell-Walsh Urology. 9th ed. Philadelphia, Pa.: Saunders Elsevier; 2007. http://www.mdconsult.com/das/book/body/171051125-2/913428548/1445/130.html?printi. Accessed Nov. 6, 2009.
- Testicular torsion. American Urological Association Foundation. http://www.urologyhealth.org/search/index.cfm?topic=134&search=men&searchtype=and. Accessed Nov. 13, 2009.
- Hittelman A. Neonatal testicular torsion. http://www.uptodate.com/home/index.html. Accessed Nov. 3, 2009.
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