Testicular Torsion

Testicular torsion occurs when the testicle rotates around the spermatic cord, which provides blood to the scrotum (a bag of skin that contains the testicles). Testicular torsion typically affects adolescents, although it can occur at all ages, including newborns and older adults. 

Testicular torsion is a very serious condition and is considered a medical emergency. Rotation of the testicle around the spermatic cord can cause obstruction of the arterial blood flow to the testicle, as well as the venous blood outflow, which can ultimately lead to necrosis or death of the testicular tissue. Treatment should be sought immediately—ideally within the first six hours from onset–to save the testicle and avoid permanent damage and necrosis. After 12 hours, the testicle may not be salvageable.

Testicular torsion is characterized by the sudden onset of acute, severe pain in the scrotum and lower abdomen, typically involving the side of the affected testicle. If testicular torsion occurs during sleep, individuals may be woken up by the pain. Individuals may also experience dizziness, nausea, and vomiting.

Testicular torsion mostly occurs in one testicle at a time; bilateral testicular torsion is very rare. Individuals with testicular torsion can present with sudden severe pain of the affected testicle, along with swelling and redness. Elevation of the scrotum can worsen the pain. Additionally, the affected testicle may move to a higher scrotal position due to the torsion and subsequent shortening of the spermatic cord.

The exact causes of testicular torsion are not clear. Most cases can be attributed to the testicle’s failure to strongly attach to the scrotum at birth, allowing the testicle to rotate inside the scrotum. Occasionally, testicular torsion is attributed to minor trauma at the scrotal area. It can also occur during sleep or after vigorous physical activity.

The diagnosis is mostly clinical, based on the presentation of the signs and symptoms of testicular torsion. These include severe pain in the scrotum and lower abdomen on the side of the affected testis, tender lumps in the scrotum, blood in semen, nausea, and vomiting.

Upon physical examination, the cremasteric reflex is absent. Normally, the cremasteric reflex can be triggered by stroking of the upper inner part of the thigh, which provokes contraction of the cremaster muscle that surrounds the testicle and spermatic cord; as a result, the testicle should move up ipsilaterally. With testicular torsion, this does not occur.

Additional diagnostic methods include urine tests to exclude infection, scrotal ultrasound (color Doppler) showing absent or decreased blood flow to the affected testicle, or even surgery to explore the area and confirm the diagnosis.

Testicular torsion is typically treated with immediate surgical detorsion, ideally within 6 hours from the onset of symptoms. Surgical detorsion consists of entering the scrotum through a small incision and untwisting the spermatic cord. The affected (or both) testicles are also stitched to the scrotum via a process called orchiopexy, so as to prevent recurrence. In some cases, manual detorsion (untwisting the spermatic cord by hand) can be performed while awaiting for definitive surgical treatment. However, orchiopexy surgery to attach the testicles to the scrotum is often still necessary. 

If the testicle cannot be salvaged, then the affected testis is surgically removed via orchiectomy. 

Testicular torsion is the rotation of the testicle around the spermatic cord, which can obstruct its blood supply and lead to necrosis. Most often, testicular torsion affects young adolescents. The most common cause is the congenital failure of the testicles to strongly attach to the scrotum. Symptoms can include sudden severe pain of the affected testicle, as well as swelling and redness. Testicular torsion is considered a medical emergency that requires treatment within the first six hours of onset to avoid permanent damage.