Introduction
Testicular torsion is one of the most frequent and important urological emergencies. Torsion, according to the Latin torquere (to turn), refers to a rotation or twisting around its own axis. This is also the case with testicular torsion, which usually leads immediately to an undersupply of the tissue. Torsion of the testis is therefore an immediate indication for surgical treatment; the faster the problem is corrected, the greater the chances of complete regeneration of the testis.
Frequency
Especially babies in the 1st year of life as well as boys, who are in puberty, often experience a testicular torsion. In 60% of cases it is the left testicle which is affected by the torsion. Every year in the age group up to 25 years a boy or young man of 4000 statistically experiences this emergency.
When a torsion occurs, it is often associated with growth, which is reflected in the frequency peaks mentioned above. But also another age does not exclude the possibility to suffer a testicular torsion of course. In recent years, more and more cases of newborns have been observed in which a torsion has already occurred in the mother’s womb.
This is usually noticed quickly after birth and must also be treated. Unfortunately, the testicular tissue is rarely preserved in these cases. Finally, testicular torsion is not an exceptionally rare disease, even in adults. In about half of the cases the torsion occurs at night, out of sleep. There is also a risk of testicular torsion during sports activities.
Symptoms of testicular torsion
A testicular torsion is characterized by an acute, very strong, permanent pain in the area of the testicle and the scrotum. Under certain circumstances, this pain can also radiate into neighboring tissue. From the outside there is usually a reddening, an enlargement of the testicle and a swelling of the testicle visible.
These signs can of course also indicate other diseases of the genital area, but arouse the suspicion of testicular torsion. Even the slightest suspicion can be an urgent emergency situation. The affected person should go to hospital immediately.
Some patients also complain of more general symptoms such as nausea, vomiting and sweating, which can accompany the acute event. As already mentioned, testicular torsion is very common in children up to 2 years of age. Indications leading to the diagnosis are naturally more difficult to interpret in infants than in older patients.
In these cases, loud, persistent crying indicates the severe pain, which cannot be specified more precisely. Other reasons for this are also conceivable, so that there is a risk of misjudging the urgency of the situation, especially in the case of rather restless children. In most cases, however, the pain is so severe and long-lasting that the child cannot be calmed down and the parents quickly notice an altered testicle.
An experienced pediatrician recognizes the emergency situation, as well as particularly vulnerable age groups, and can quickly give correct advice by palpating the testicle. Nevertheless, it is advisable to take the child to the nearest hospital without detours. A characteristic feature of testicular torsion is severe pain that occurs suddenly and does not get weaker.
Starting at the testicles, they can radiate into the groin, and under certain circumstances also into the lower abdomen. The scrotum is reddish or blue-red discolored and inflated. The skin folds, which are normally visible, have elapsed and are no longer visible.
On touching or pressure on the testicles, an affected person feels strong pain. In absolutely exceptional cases a testicular torsion can be painless. These cases are the great exception.
