TESTICULAR TORSION

Testicular Torsion

Testicular torsion refers to the twisting of the organ around the axis of the spermatic tone.

The spermatic tone resembles a cord by which the testicle hangs.

The spermatic tone carries a collection of testicular vessels and nerves.

When the organ is twisted, the blood flow is stopped and, without timely treatment, it causes ischemia and tissue death.

Risk factors

  • Cryptorchidism
  • Groin area injury
  • Vigorous physical activity
  • In some cases, there is no distinct cause (idiopathic)

Symptoms

The disease has a very dramatic clinical presentation.

Most common symptoms include:

  • Sudden testicular pain
  • Nausea and vomiting
  • Hard enlargement of the scrotum
  • If testicular torsion does not receive timely treatment, the pain gradually decreases and this is a sign of organ necrosis.

Diagnosis

Usually, patient medical history and clinical examination are sufficient to establish the diagnosis.

To confirm the diagnosis and differentiate it from other conditions which exhibit similar symptoms, e.g. orchiepididymitis, a color Doppler ultrasound of the scrotum is required.

When the diagnosis is ambiguous, it is preferable that the testicle is surgically investigated and the possible torsion is restored.

Treatment

Testicular torsion constitutes an emergency and requires immediate surgical treatment.

Performing a scrotal incision, the torsion is reduced and, if the testicle is viable, it is fixed onto the scrotum to avoid a new torsion.

In cases when the testicle is determined as non-viable, orchiectomy is recommended.

Typically, the rate of testicular viability is 83%, if the reduction is carried out up to 5 hours from symptom onset, and 20% if more than 12 hours have passed since symptom onset.

Consequently, every passing hour is vital.