Testicular Torsion – Urology Emergency
1 out of 400 males under the age of 25 years are affected by testicular torsion and approximately 400 males a year will lose a testicle due to the delay in presentation to the doctor or delay/misdiagnosis. Approximately 36-39% of patients who have lost a testicle are found to have subfertility. It can occur at any age although it is rare over the age of 30 years. Approximately 65% of cases occur in ages 12-18 years.
Testicular torsion occurs when the testicle rotates, twisting the spermatic cord that brings blood supply from the abdomen to the scrotum. The reduced blood flow causes sudden, often severe pain and swelling to the groin area. It is a urology emergency and whilst it is serious it is treatable. However treatment needs to be prompt as delay in diagnosis of testicular torsion can lead to the death of the testicle and surrounding tissue as a result of loss of blood flow.
Testicular torsion normally requires emergency surgery, although manual untwisting is sometimes possible, but surgery can prevent it reoccurring. If it is treated within 4-6hours, the testicle can usually be saved. However, delay in this time frame can result in the testicle and surrounding tissue dying and the testicle having to be removed.
The surgery is normally conducted under general anaesthetic and to attach the testicle to the scrotum does not usually require a stay in hospital. The sooner the testicle is untwisted, the greater chance of saving the testicle. Left untreated, after 6 hours lasting damage may occur and after 12 hours there is a 75% chance of losing the testicle. After 48 hours, majority of patients will need to have the affected testicle removed. Once the testicle is dead, it must be removed to prevent gangrenous infection. Although it is rare 2 out of 100 patients will go one to experience torsion in the other testicle.
Symptoms;
Testicular torsion can happen at anytime, while standing, sleeping, exercise or sitting. It usually appears suddenly although in some cases, the torsion can develop over a few days. Below are some typical symptoms to watch out for;
- Sudden or severe pain in one testicle
- Swelling of the scrotum
- Lumps in the scrotum
- Abdominal pain
- Nausea and/or vomiting
- Blood in the semen
- A testicle is positioned higher than normal or at an unusual angle
- Painful urination
- Fever
- Redness/black coloring to the testicle/scrotum area
Males with testicular torsion typically wake up due to the scrotal pain in the middle of the night or in the morning. It may be prompted by an injury or because of rapid growth during puberty.
In some cases the sudden pain in the testicle may go away without any treatment, this may be due to the testicle untwisting without intervention. However, it is still important to seek prompt medical help because surgery may still be needed to prevent the problem from happening again.
Testicular torsion can affect newborns and infants. In these circumstances, the testicle usually cannot be saved and surgery is required to ensure the other torsion does not occur in the other testicle and to prevent future reproductive problems.