What is Testicular Torsion

Testicular torsion is a rare but serious condition, especially in men. Torsion itself means sudden twisting of one end of an object relative to the other. So, testicular torsion implies that a male testicle twists by itself, cutting off its blood supply. With no blood circulating to the testes, if not restored within 6 hours, this will need surgical intervention, resulting in the removal of the twisted testicle.

Needless to say, this is a very painful condition. The spermatic cord is responsible for the blood flow to the testicles. This is a kind of medical emergency, and if not treated in time, it may lead to infertility in men.

What are the Types of Testicular Torsion?

Intravaginal Torsion

Intravaginal torsion is the most common type of testicular torsion, usually seen in adolescents and adults. It occurs when the testis rotates within the tunica vaginalis, a protective sac surrounding the testicle. This twisting cuts off blood flow, causing sudden and severe scrotal pain, swelling, and sometimes nausea or vomiting. Prompt diagnosis is crucial, as ischemia can lead to permanent testicular damage. Surgical intervention, usually orchidopexy, is required to untwist and secure the testis.

Extravaginal Torsion

Extravaginal torsion typically occurs in newborns and infants. Unlike intravaginal torsion, the testis, epididymis, and tunica vaginalis all twist together outside the tunica vaginalis. This form results from incomplete attachment of the testis to the scrotal wall during fetal development. It presents as a firm, enlarged, and often discoloured scrotum at birth. Immediate surgical management is essential to salvage the testicle, though prognosis may be poorer than in older children due to early vascular compromise.

What Causes Testicular Torsion?

This condition might happen to anyone, at any age. Research suggests that under the age of 25, about 1 in 4000 men can have this condition. Adolescent males contribute to about 65% of the total cases of testicular torsion.

This is a spontaneous event that can cause sudden, excruciating pain and may even happen to infants. In this case, doctors act as quickly as possible to avoid having to remove a testicle.

It has been observed that the left testicle is the most affected in such cases. The torsion usually happens on one testicle and not on both. However, other conditions might result in impacting both.

There are no sure-shot indications as to what causes a testicular torsion. However, here are some probable causes that lead to this:

• Direct injury to the testicle: this can trigger torsion.
• Bell clapper deformity: In most men testicle is attached to the scrotum so the testicle can hang around freely. This, in turn, can trigger torsion. In this condition, torsion can occur in both testicles, making the situation more severe.

If the testes die in the process, the scrotum becomes tender and swollen. It will take a long time for the body to recover from the trauma.

What are the Signs & Symptoms of Testicular Torsion?

A sudden onset of severe testicular pain is a sure sign of testicular torsion. This can occur at any time of the day, in any position. So it can happen when you’re awake/ asleep/ standing/ sitting, anytime. It does not depend on any physical activity.

Here are the times one should seek emergency medical attention:

• In case there is any abrupt or intense pain in one testicle, then it can be an indication of serious conditions like testicular torsion. It should be evaluated immediately since early diagnosis is important to prevent permanent damage.
• If you notice swelling on one side of the scrotum, then it can be a warning sign that you shouldn’t ignore.
• A palpable lump is abnormal since testicles are usually the same size. It may indicate a tumour, cyst, or torsion.
• If you notice your skin colour changing, then it can also be an indication of infection, inflammation, or impaired blood flow.
• In case you feel pain or a burning sensation during urination, that can also be a sign of infection.
• When pain or swelling is accompanied by nausea or vomiting, the situation is potentially urgent and requires immediate medical care.
• Even mild or intermittent pain should not be ignored. Prompt evaluation is essential to prevent complications and preserve testicular health.

Risk Factors for Testicular Torsion

• Age- This condition is common for male individuals between the ages of 12 and 18, though it can occur at any age. The chances increase for men going through puberty because of hormonal changes.

• Undescended Testicles- Males with a history of undescended testicles are at higher risk, as abnormal testicular attachment can predispose to torsion.

• Bell Clapper Deformity- This is a congenital condition where the testicle is not properly attached to the scrotum. This allows the scrotum to rotate freely within the tunica vaginalis. It can also cause testicular torsion.
• Family Medical History- If any male relative in your family has suffered from this condition, then there is a high likelihood of susceptibility, suggesting a genetic component.

• Trauma or Injury- In case of a sudden injury to the scrotum, it can trigger torsion. It is not necessary in every case, but the chances increase if anatomical predispositions exist.

• Previous Torsion-  Having experienced torsion in one testicle increases the risk for recurrence, particularly if surgical fixation was not performed.

How is Testicular Torsion Diagnosed?

An expert urologist will perform a testicular torsion diagnosis through physical examination, understand your symptoms, and medical history. A scrotal ultrasonography with Doppler signalling can be performed to assess the flow within the testicular tissue.

If a urinary tract infection is detected in the process, further investigative tests will be prescribed. Further on the urologist will check for an infection in the testicle or epididymis behind the testes.

Complications of Testicular Torsion

Here are some of the complications that can happen if testicular torsion is left untreated:

• Testicular Infarction – This also means death of testicular tissue. In this when the blood supply is blocked for too long, the testicle can suffer irreversible damage. You must go for prompt treatment to prevent it.

• Loss of the testicle– It is also known as orchiectomy, where the testicle cannot be saved anyway. It must be removed surgically.

• Infertility or reduced fertility– Damage to one testicle, especially if both are affected, can impair sperm production and hormone function, impacting fertility.

• Chronic pain- Even after successful treatment, you can experience long-term scrotal or testicular pain.

• Recurrence of Torsion- Without proper surgical fixation (orchidopexy), torsion can recur in the affected or opposite testicle.

• Infection from the surgery– Rarely, surgical treatment can lead to infection, bleeding, or scarring in the scrotum.

Testicular Torsion Surgery: What to Expect

• Purpose of Surgery- The surgery is performed with only one intention: to untwist the affected testicle and restore blood flow. If the testicle is viable, it is fixed to the scrotum to prevent recurrence. In some extreme cases, surgery is done to remove the testicles completely.
• Preparation- The surgery is generally done under general anesthesia. Before surgery, you might be instructed to abstain from food and drinks for a few hours. To confirm torsion, preoperative investigations may involve imaging and blood work.
• During the Surgery- The surgeon makes a small incision in the scrotum, untwists the testicle, and assesses its blood supply. In case the testicle is healthy, it is fixed to prevent future torsions; if not, then it is removed completely.
• Recovery- Patients may experience mild pain, swelling, or bruising after the surgery. It can be managed with medications.
• Postoperative Care-  Keep the incision area clean and dry. Avoid strenuous activity, heavy lifting, or sexual activity for a few weeks as advised by your doctor. Follow-up visits are necessary to monitor healing.
• Risks and Complications- Rare complications include infection, bleeding, scarring, or recurrence of torsion. Permanent damage or loss of the testicle may occur if surgery is delayed.

How is Testicular Torsion Treated?

Torsion must be treated quickly. Even in the emergency room, the urologist will have to make sure that the untwisting is securely done. For this, they will untwist the cord surgically and secure it with a few stitches through the scrotum or groin to prevent it from recurring.

If the testicle is beyond repair, the surgeon will secure the other testicle and prepare to remove the non-functioning twisted testicle. The need for testicular torsion surgery varies from case to case. For newborns, pediatric urologists will remove the infarcted testicle, secure the second testis with stitches.

Sadly, in the case of infants, the detection and testicular torsion has a very small window of time. In most cases, the surgery results in the removal of one or both testicles. There is a higher chance of children and adolescents suffering from this condition. Mostly, this condition is hereditary and can be passed down genetically. However, even if a testicle is removed, there is nothing to be alarmed about. The fertility is not impacted, as a single testicle is equally capable of producing enough sperm. So life after testicular torsion surgery is not all that bad. Once the area heals, you can also look for prosthetic options to improve the appearance.

It is a very difficult condition and requires immediate professional attention. This is why you must rush to the hospital emergency department when in pain and ask for a urologist. An experienced expert will ensure that the surgery is minimally invasive and timely to ensure that the testicle is saved.

How to Prevent Testicular Torsion

• Go for an evaluation whenever you see symptoms, like pain, redness, or swelling in the testicles.

• If you have a history of medical conditions like a congenital anatomical difference, then you are at high risk of having testicular torsion. Go for orchidopexy to secure the testicles to the scrotum and prevent them from rotating.

• Wear supportive athletic gear, such as a jockstrap or cup, during contact sports to reduce the risk of trauma to the testicles.

• Check for lumps or any kind of changes in your testicles. Early identification of abnormalities can prevent complications.

• Correcting undescended testicles in childhood reduces the risk of torsion later in life.

FAQs :

How painful is a testicular torsion?

It is a severe and painful condition that needs immediate medical attention. This is similar to getting an irreversible cramp in your testicle, as if someone has twisted it and there is no way to untwist it.

Who gets Testicular Torsion?

It has been observed that 1 of 4000 males gets testicular torsion. Mostly, the condition is inherited and often affects both testicles. It has a higher chance of occurring in people below the age of 25 years. The majority of the affected age group is attributed to teenagers between the ages of 12-18 years.

How Is Testicular Torsion Diagnosed?

First and foremost, the doctors will identify the problem area and the affected testicle through a physical pelvic examination or an ultrasound. Eventually, testicular torsion surgery is a must. However, in the emergency room, the resident doctor will try to manually untwist the cord. But surgery is inevitable, as there will be sutures needed to secure the testicle after untwisting it to prevent recurrences. Once the blood flow is restored to the area, the crisis is averted. Through the scrotum or via an incision through the groin, either way the surgeon will take extra care to restore the blood flow without damaging the tissues. In case of the patient having a bell clapper condition, care will be taken to secure both testicles, as it is more critical.

Is Testicular Torsion Common?

Testicular torsion is relatively uncommon but most frequently occurs in adolescent males aged 12–18. Early recognition and treatment are crucial to prevent testicular damage.

Can Testicular Torsion Fix Itself?

No, testicular torsion cannot fix itself. Immediate medical or surgical intervention is necessary to untwist the testicle and restore blood flow, or permanent damage may occur.