Testicular Torsion - Causes, Symptoms, Treatment & Prevention

What is Testicular Torsion?

Testicular torsion is a male urological medical condition where the testicles rotate, twisting the spermatic cord and bringing blood to the scrotum. It results in reduced blood flow and causes sudden and often severe pain and swelling. Testicular torsion is most commonly experienced by men between 12 to 18 years. Generally, testicular torsion requires emergency surgery as the situation is painful and causes severe discomfort to the patient. If the blood flow has been cut too long, a testicle may become damaged and require surgical removal. 

Testicular Torsion Symptoms

Testicular torsion is a medical emergency that occurs when the spermatic cord, which provides blood supply to the testicle, becomes twisted, cutting off the blood flow. 

Here are some of the common testicular torsion symptoms observed by the patients:

• Sudden and severe testicular pain: The most common symptom is a sudden onset of intense pain in one testicle. The pain can be excruciating and may come on rapidly without any apparent cause or injury.
• Swelling and redness: The affected testicle may become swollen and appear larger than the other one. It might also become red or darker in color.
• Abdominal pain: Some individuals may experience lower abdominal pain or discomfort along with testicular pain. This occurs because the nerves supplying the testicles and abdomen are connected.
• Nausea and vomiting: Testicular torsion can cause nausea, vomiting, and feeling lightheaded or dizziness. These symptoms may be a result of severe pain or the physiological response to decreased blood flow.

• Testicular firmness or elevation: The affected testicle may feel firm or hardened. In certain cases, the testicle might be positioned higher than usual within the scrotum.

Testicular Torsion Causes

Testicular torsion can happen when the spermatic cord twists, cutting off blood flow to the testicle. It can be caused by physical activity, trauma, or even just the way the testicles are positioned. It is important to seek medical help right away if you suspect testicular torsion. The exact causes of testicular torsion are not always clear, but here are several factors that can contribute to its occurrence:

• Inadequate attachment: Testicular torsion can be caused by a lack of proper attachment of the testicles within the scrotum. If the tissues that normally hold the testicles in place are loose or weak, it increases the risk of torsion.
• Physical activity or trauma: Vigorous physical activity, such as sports or strenuous exercise, can sometimes trigger testicular torsion. Additionally, trauma or injury to the scrotum can increase the likelihood of torsion.
• Anatomical abnormalities: Some individuals are born with anatomical variations that make them more susceptible to testicular torsion. These abnormalities can include the presence of a high-lying testicle (bell clapper deformity) or an unusually loose spermatic cord.
• Previous history of torsion: If an individual has previously experienced testicular torsion in one testicle, they may be at increased risk of it occurring in the other testicle.

The testicular torsion can occur spontaneously and without any identifiable cause. Regardless of the cause, testicular torsion is a medical emergency that requires immediate medical attention to prevent permanent damage to the testicle.

Types of Testicular Torsion

Testicular torsion is a situation where the spermatic cord gets twisted, there are two primary types of testicular torsions:

• Extravaginal torsion: This type of torsion occurs when the testicle twists inside the scrotum. It is the most common form of testicular torsion, accounting for about 95% of cases. Extravaginal torsion typically happens due to an anatomical abnormality, such as the presence of a high-lying testicle or a loose attachment of the spermatic cord.
• Intravaginal torsion: Intravaginal torsion occurs when the testicle twists within the tunica vaginalis, which is a protective membrane that covers the testicle. It is less common than extravaginal torsion and is often associated with a history of previous testicular trauma or injury. Intravaginal torsion can occur in individuals with a normal scrotal anatomy, and the twisting may be triggered by sudden movements or physical activity.

Both types of testicular torsion can lead to a reduction or complete cutoff of blood supply to the testicle, resulting in severe pain and potential damage to the testicular tissue. Prompt medical intervention is necessary to untwist the testicle and restore blood flow to prevent long-term complications or loss of the testicle.

Diagnostic Tests and Health Screenings Done for Testicular Torsion

Testicular torsion is a medical emergency that requires immediate diagnosis and treatment. The diagnostic tests and health screenings commonly done for testicular torsion include:

• Physical examination: A healthcare provider will conduct a thorough physical examination, which involves inspecting the scrotum, palpating the testicles, and assessing for signs of swelling, tenderness, or changes in testicular position.
• Medical history: The healthcare provider will inquire about the individual’s symptoms, including the onset and duration of pain, any preceding trauma, and any previous history of testicular torsion.
• Ultrasound: An ultrasound examination of the scrotum is generally performed to evaluate blood flow to the testicles. This imaging test can help determine if the testicle is twisted and if blood flow to the affected testicle is compromised. Ultrasound is a non-invasive and effective method for diagnosing testicular torsion.
• Blood tests: Blood tests may be performed to look for infection or inflammation in the body, which can cause symptoms similar to testicular torsion.
• Urine tests: A urine test is usually performed to rule out a urinary tract infection, which can cause scrotal pain.

Immediate surgical exploration is often recommended if there is a high clinical suspicion of testicular torsion. Time is of the essence in testicular torsion cases, and delaying surgical intervention for confirmatory tests can lead to testicular damage or loss.

Treatment Options for Testicular Torsion

The primary treatment for testicular torsion is surgical intervention, as it is a medical emergency that requires immediate attention. The choice of surgical technique may depend on the severity of the torsion, the condition of the testicle, and the individual’s specific circumstances. The goal of treatment is to untwist the testicle and restore blood flow to prevent tissue damage and potential loss of the testicle.

The surgical options for treating testicular torsion include:

• Manual detorsion: In some cases, if the torsion is detected early and the testicle has not suffered significant damage, the healthcare provider may attempt manual detorsion. This procedure involves manually rotating the testicle in the opposite direction to untwist it. Manual detorsion is majorly performed under the effect of anesthesia and can provide temporary relief, but it is not a definitive treatment and surgical fixation is still required to prevent a recurrence.
• Orchidopexy: Orchidopexy, also known as orchiopexy, is the surgical procedure performed to treat testicular torsion. It involves surgically fixing the affected testicle to the scrotum or the surrounding tissues to prevent future torsion. During the procedure, the healthcare provider will untwist the testicle, assess its viability, and secure it in place using sutures or other techniques. Orchidopexy is typically performed under general anesthesia.

What happens if the testicular torsion is not treated?

Testicular torsion is a curable medical condition and should be taken care of on time. If it is not promptly treated, it can lead to serious complications, including:

• Testicular ischemia: Testicular torsion cuts off the blood supply to the affected testicle, leading to ischemia (lack of blood flow). Without a sufficient blood supply, the testicle does not receive the oxygen and nutrients needed for its proper function and survival. Prolonged ischemia can result in irreversible damage to the testicular tissue.
• Testicular infarction: If the blood supply to the testicle remains compromised for an extended period, the lack of oxygen and nutrients can lead to testicular tissue death, known as testicular infarction. This can result in the loss of the affected testicle.
• Epididymitis: In some cases, the compromised blood flow and tissue damage caused by testicular torsion can lead to inflammation and infection of the epididymis, a coiled tube located on the back of the testicle. This condition is known as epididymitis and can cause additional pain, swelling, and discomfort.
• Fertility issues: While testicular torsion primarily affects the blood supply to the testicle, it can also impact the function of the seminiferous tubules within the testicle that produce sperm. Prolonged torsion and resulting tissue damage can decrease sperm production and potentially affect fertility in the future.

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How to prevent testicular torsion?

Preventing testicular torsion can be challenging since it is often caused by anatomical factors that are beyond an individual’s control. 

However, here are a few considerations that may help prevent testicular torsion: 

• Awareness and education: Being aware of the symptoms and risk factors associated with testicular torsion can help individuals recognize the signs and seek prompt medical attention. Educate yourself about the symptoms of testicular torsion and the importance of seeking immediate medical care if you experience sudden and severe testicular pain.
• Protect the scrotum: Engaging in activities that may pose a higher risk of trauma to the scrotum, such as contact sports, should be done with caution. Wearing protective equipment, such as a cup or athletic supporter, during sports activities can help reduce the risk of injury to the testicles.
• Regular self-examination: Perform regular self-examinations of the testicles to become familiar with their normal size, shape, and consistency. If you notice any changes, lumps, or swelling, consult a healthcare professional for evaluation.
• Medical evaluation for anatomical abnormalities: If the patient has a family history of testicular torsion or known anatomical abnormalities, it may be advisable to consult with a healthcare professional. They can assess the risk of torsion and discuss potential preventive measures, such as prophylactic surgical fixation (orchiopexy).
• Timely treatment of testicular pain: If you experience testicular pain that is not severe or sudden but persists or worsens over time, it is still important to seek medical evaluation. Some cases of testicular torsion may present with milder or intermittent pain before progressing to a more severe stage.

While these measures may help reduce the risk of testicular torsion, they cannot guarantee prevention. If you suspect testicular torsion or experience sudden and severe testicular pain, immediate medical attention is crucial.