Torsion of the testicle is an uncommon but serious condition in which the testicle twists on the cord that provides its blood supply. The twisting of this cord cuts off the blood supply to the testicle. It is extremely painful and must be treated immediately to prevent permanent damage to the testicle. Testicular torsion can happen after strenuous exercise or an injury, but it also can occur without any apparent cause. The condition can occur at any age but is most common between the ages of 10 and 20.
Sudden onset of severe pain and extreme tenderness in one testicle, with or without an obvious cause, is the most striking symptom. Other symptoms include nausea and vomiting associated with the pain, and swelling on one side of the scrotum.
The diagnosis is based largely on the symptoms described above and a physical examination. The testicle may be raised high in the scrotum on the affected side. Your doctor will try to make sure the symptoms aren't caused by other conditions that affect the testicle and scrotum, including epididymitis (inflammation of the cord-like seminal duct, located behind the testicle) and orchitis (inflammation of the testicle itself, often caused by infection). Under certain circumstances, a testicular cancer or tumor can present with symptoms similar to a testicular torsion. This occurs because there may be some bleeding into a testis cancer which can cause the same type of pain and swelling as a torsion of the testis. An ultrasound test to examine the contents of the scrotum may help sort out the cause. Some institutions will also perform a testicular scan which can sometimes be helpful in distinguishing one cause from another. Sometimes, surgery is necessary to make a definite diagnosis. It's important for the condition to be diagnosed rapidly to ensure the best outcome.
Occasionally, the testicle may untwist on its own, causing immediate relief from the swelling and pain. There are some occasions when the patient can "untwist" the testis itself, but usually immediate medical attention is essential. Do not wait for the testicle to untwist on its own. Testicular torsion must be treated within a few hours to prevent permanent damage
Most cases of testicular torsion cannot be prevented. However, there are boys who may comment that they are able to "spin" their testis around in the scrotum and then "spin" it back into its normal position. If this occurs, it may be very helpful for the person to seek the advice of a urologist. The urologist may suggest a procedure called an orchiopexy -- an operation that surgically sews the bottom of the testicle to the wall of the scrotal sac (the sac that holds the testicles) to prevent the subsequent development of a torsion.
This condition is a surgical emergency. Sometimes, a urologist (a doctor who specializes in illnesses of the urinary tract and male reproductive organs) will attempt to untwist the testicle by hand. If this is not successful, immediate surgery is needed to save the testicle. An incision is made in the scrotum so that the cord can be untwisted and the testicle anchored in place with a couple of stitches that attach the outside lining of the testis to the scrotal wall. This procedure is called an orchiopexy. If the testicle has been damaged by an absence of blood flow, it may have to be removed. The unaffected testicle also may be anchored during surgery to prevent it from twisting in the future.
Most people with testicular torsion will need to be evaluated in an emergency room. Seek medical attention for severe pain on one side of the scrotum that persists for more than a few minutes, especially if it is associated with swelling, nausea and vomiting. Again, it is very important that a correct diagnosis be established, especially to eliminate the possibility of testicular cancer.
The testicle will usually recover quickly and completely if the condition is corrected immediately. If the blood supply to the testicle is cut off for a prolonged period, the testicle may need to be removed surgically. Most men who have had testicular torsion will have normal fertility and sexual function.
American Academy of Family Physicians (AAFP)
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American Urological Association
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