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Testicular Torsion

Testicular Torsion: Causes, Symptoms, Diagnosis, Treatment, and Prevention

A testicular torsion occurs when one or both testicles (the male reproductive organs responsible for producing sperm and hormones) twist around the spermatic cord (the tube connecting the testicles to the rest of the body). In this case, the blood supply to the affected testicle is cut off, leading to severe pain, swelling, and even testicle damage or loss.

Causes of Testicular Torsion

Testicular torsion can happen for various reasons, but it is more common in boys and young men between the ages of 12 and 18. Some of the possible causes are:

  • Congenital defect: Some people are born with a condition called bell clapper deformity, which means that the testicles are not attached properly to the scrotum (the sac that holds the testicles). This makes them more likely to twist around the spermatic cord.

  • Trauma or injury: A direct blow or impact to the scrotum can cause the testicles to twist. This can happen during sports, accidents, or fights.

  • Physical activity: Sometimes, testicular torsion can occur spontaneously during or after physical activity, such as running, jumping, or lifting heavy objects. This can cause the testicles to move around in the scrotum and twist.

  • Cold temperature: Exposure to cold temperature can cause the scrotum to contract and pull the testicles closer to the body. This can also increase the risk of testicular torsion.

Symptoms of Testicular Torsion

The main symptom of testicular torsion is sudden and severe pain in one or both of the testicles. The pain may also spread to the lower abdomen or groin area. Other symptoms may include:

  • Swelling and redness of the scrotum and the affected testicle

  • Nausea and vomiting due to the intense pain

  • Fever due to the inflammation and infection of the testicle

  • Abnormal position of the testicle, such as higher or lower than usual, or at an odd angle

  • Difficulty urinating or passing stool due to the pressure on the bladder or rectum

Diagnosis of Testicular Torsion

A testicular torsion is a medical emergency that requires immediate treatment to save the testicle and prevent complications. To diagnose testicular torsion, your doctor may perform the following tests:

  • Ask you about your symptoms and medical history, such as when the pain started, how severe it is, and if you have any previous episodes of testicular torsion or trauma to the scrotum

  • Examine your scrotum and testicles to check for signs of swelling, redness, tenderness, and abnormal position

  • Perform tests to confirm the diagnosis and rule out other possible causes of testicular pain, such as infection, inflammation, or tumor. These tests may include:

    • Ultrasound: This is a painless and non-invasive test that uses sound waves to create images of the testicles and the blood flow to them. It can show if the testicle is twisted and if the blood supply is cut off

    • Urine and blood tests: These are simple and quick tests that can detect signs of infection or inflammation, such as bacteria, white blood cells, or elevated levels of certain proteins

    • Nuclear scan: This is a rare and more invasive test that involves injecting a small amount of radioactive material into the bloodstream and using a special camera to see how it travels to the testicles. It can also show if the blood flow to the testicle is blocked

Treatment of Testicular Torsion

Testicular torsion treatment depends on the severity and duration of the condition. The main goal is to restore blood flow to the testicle so that permanent damage or loss doesn't occur. Possible treatments include:

  • Manual detorsion: This is a procedure that involves gently twisting the testicle back to its normal position by hand. It can be done by a doctor or by yourself, if you know how to do it and if the pain is not too severe. It can provide temporary relief, but it is not a definitive treatment, as the testicle may twist again

  • Surgical treatment is the most effective and definitive way to treat testicular torsion. A small incision is made in the scrotum and the testicle is untwisted. The surgeon may also stitch the testicle to prevent it from twisting again. Usually, orchidopexy is performed under general anesthesia and takes about an hour. It has a high success rate, especially if performed within 6 hours of onset of symptoms.

Prevention of Testicular Torsion

Testicular torsion is not always preventable, but there are some steps that you can take to reduce the risk of it happening, such as:

  • Wearing protective gear when playing sports or engaging in activities that may cause trauma to the scrotum, such as a cup or a jockstrap

  • Avoiding sudden movements that may cause the testicles to twist, such as jumping, running, or lifting heavy objects

  • Keeping the scrotum warm by wearing loose-fitting underwear and clothing, and avoiding exposure to cold temperature

  • Checking your testicles regularly for any changes in size, shape, or position, and reporting any abnormalities to your doctor

If you experience any of the symptoms of testicular torsion, do not delay seeking medical care. Testicular torsion can affect your fertility and quality of life. If you get treated right away, your testicle is more likely to be saved and complications will be avoided.

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