Torsion testis occurs when a testicle rotates, twisting the spermatic cord that brings blood to the scrotum. The reduced blood flow causes sudden and often severe pain and swelling.
Torsion testis is most common between ages 12 and 16, but it can occur at any age, even before birth.
Torsion testis usually requires emergency surgery. If treated quickly, the testicle can usually be saved. But when blood flow has been cut off for too long, a testicle might become so badly damaged that it has to be removed.
What are the symptoms of torsion testis?
Signs and symptoms of torsion testis include:
- Sudden, severe pain in the scrotum - the loose bag of skin under the penis that contains the testicles
- Swelling of the scrotum
- Abdominal pain
- Nausea and vomiting
- A testicle that's positioned higher than normal or at an unusual angle
- Painful urination
Young boys who have torsion testis typically wake up due to scrotal pain in the middle of the night or in the morning.
Causes of torsion testis
Torsion testis occurs when the testicle rotates on the spermatic cord, which brings blood to the testicle from the abdomen. If the testicle rotates several times, blood flow to it can be entirely blocked, causing damage more quickly.
It's not clear why torsion testis occurs. Most men who get torsion testis have an inherited trait that allows the testicle to rotate freely inside the scrotum. This inherited condition often affects both testicles. But not every individual with the trait will have testicular torsion.
Torsion testis often occurs several hours after vigorous activity, a minor injury to the testicles or sleep. Cold temperature or rapid growth of the testicle during puberty also might play a role.
Risk factors associated with Torsion testis
- Age. Torsion testis is most common between ages 12 and 16.
- Previous testicular torsion. If anyone had testicular pain that went away without treatment (intermittent torsion and detorsion), it's likely to occur again. The more frequent the bouts of pain, the higher the risk of testicular damage.
- A family history of testicular torsion. The condition can run in families.
Complications related to Torsion testis
Torsion testis can cause the following complications:
- Damage to or death of the testicle. When torsion testis is not treated for several hours, blocked blood flow can cause permanent damage to the testicle. If the testicle is badly damaged, it has to be surgically removed.
- Inability to father a child. In some cases, damage or loss of a testicle affects a man's ability to father a child.
Having testicles that can rotate in the scrotum is a trait inherited by some males. If someone has this trait, the only way to prevent testicular torsion is surgery to attach both testicles to the inside of the scrotum.
Diagnosis of Torsion testis
The doctor will ask the patient some questions to verify whether his signs and symptoms are caused by torsion testis or something else. Doctors often diagnose testicular torsion with a physical exam of the patient's scrotum, testicles, abdomen and groin.
The doctor might also test the patient's reflexes by lightly rubbing or pinching the inside of his thigh on the affected side. Normally, this causes the testicle to contract. This reflex might not occur if you have testicular torsion.
Sometimes medical tests are necessary to confirm a diagnosis or to help identify another cause for your symptoms. For example:
- Urine test: This test is used to check for infection.
- Scrotal ultrasound: This type of ultrasound is used to check blood flow: Decreased blood flow to the testicle is a sign of testicular torsion. But ultrasound doesn't always detect the reduced blood flow, so the test might not rule out testicular torsion.
- Surgery: Surgery might be necessary to determine whether the patient's symptoms are caused by torsion testis or another condition.
If someone has pain for several hours and his physical exam suggests torsion testis, he might be taken directly to surgery without any additional testing. Delaying surgery might result in loss of the testicle.
Treatment of Torsion testis
Surgery is required to correct torsion testis. In some cases, the doctor might be able to untwist the testicle by pushing on the scrotum (manual detorsion). But he will still need surgery to prevent torsion from occurring again.
Surgery for torsion testis is usually done under general anesthesia. During surgery, the doctor will make a small cut in the patient's scrotum, untwist his spermatic cord, if necessary, and stitch one or both testicles to the inside of the scrotum.
The sooner the testicle is untwisted, the greater the chance it can be saved. The risk that the patient will need testicle removal is 5% when treatment occurs within six hours of the occurrence of pain. The risk increases up to 90% when treatment occurs more than 48 hours after the pain begins.