Testicular Torsion

Testicular torsion describes a condition in which a testicle becomes twisted within the scrotum, causing the blood supply to the testicle to become blocked. WIthout sufficient blood flow, the testicle can die due to lack of oxygen and, in severe cases, may need to be removed. 1 Therefore, suspected testicular torsion should be treated as a medical emergency.

Newborns, children and adolescents are most often affected, although it can occur at any age and without warning.

The most common symptom of testicular torsion is sudden pain on one side of the scrotum, sometimes accompanied by nausea and vomiting.

Diagnosis of testicular torsion is usually based on a physical examination and ultrasound of the scrotum. The treatment is surgery to untwist the testicle and reposition it within the scrotal sac. Surgery should take place as soon as possible to prevent permanent damage to the testicle. With early diagnosis and surgery, most people make a full recovery.

The most common initial symptom or sign of testicular torsion is sudden and severe testicular pain. Typically, the pain only occurs on one side of the scrotum. This is because usually only one testicle at a time is affected. Torsion in both testes only affects roughly 2 in 100 men with the condition. 2 Although the pain tends to be most severe in the affected testicle, the lower abdomen may also become tender and painful.

Following the onset of pain, affected people may also experience a number of other symptoms, including: 1 2 3

• Nausea and vomiting
• Swelling of the scrotum
• Abnormal changes to the color of the scrotum, in particular redness or darkening
• Abnormal changes to the position of the testicle, including elevation or lying at an unusual angle
• The need to urinate frequently
• Fever

In most cases of testicular torsion, long-term damage can be avoided if the condition is treated within six hours of the onset of symptoms. 4 It is an emergency condition, so always contact a doctor immediately if testicular torsion is suspected.

Some people may experience severe, but temporary, testicular pain which lasts for just a few minutes. This can be the result of the testicle twisting, but returning back to normal of its own accord. 5 Even if short-term, any sharp pain or discomfort in the testes is a sign that medical help should be sought right away.

Testicular torsion occurs when a testicle moves freely within the scrotum, twisting the spermatic cord that it is attached to. When the spermatic cord becomes twisted, blood flow between the abdomen and the affected testicle becomes restricted. A testicle without blood supply can quickly become damaged and, if blood flow is not restored in time, may die. 1

Most cases of testicular torsion occur in people who are born with a condition called bell clapper deformity. 6 This condition means the testicle is not adequately attached to the scrotal wall and hangs freely, resulting in a predisposition to rotation. Bell clapper deformity is only present in about 12 percent of men. 7

However, testicular torsion can still occur in people without bell clapper deformity. Tissues connecting the testes to the scrotum usually prevent the testes from rotating. In some people these surrounding tissues are too loose, which can result in a greater level of testicular movement and the risk of torsion occurring.

Testicular torsion is not a common condition, with roughly only 1 in 4,000 people under the age of 25 experiencing it annually. 8 A number of factors can increase the risk of it occurring, such as: 3 4 6 9 10

• Age. Testicular torsion is most common in adolescents between 12 to 18 years of age. Newborn babies and toddlers are also more likely to experience the condition. It is rare over the age of 30.
• Genetics. A family history of testicular torsion, or bell clapper deformity, increases the chances of experiencing the condition.
• Previous testicular torsion: People who have been previously affected by the condition are more likely to encounter it again.
• Exercise. Strenuous exercise and movement can result in increased chance of the testicle twisting.
• Trauma. In rare cases, testicular torsion may occur after an injury to the scrotum.
• Climate. Testicular torsion can occur when cold weather causes the already-twisted testicle to suddenly contract, trapping the twist in place.

Good to know: Although there are established risk factors, testicular torsion can occur spontaneously without the presence of any risk factors at all. 4 If testicular torsion is suspected, always contact a doctor immediately.

The diagnosis is often suspected based on the symptoms and appearance of the scrotum. The diagnosis is usually confirmed with an ultrasound scan or, very commonly, during emergency surgery. Urine and blood tests may also be done to exclude any other cause for the symptoms.

Treatment is a surgical procedure to untwist the testicle and fix it to the scrotum. If the testicle has been severely damaged, it will be removed.

Although it is not possible to prevent testicular torsion, good surgical management can prevent the testicle from becoming twisted again.