Testicular torsion, the twisting of the testicle and associated structures such as the spermatic cord, is an extremely painful condition. It primarily affects infants and young children, but testicular torsion can also occur abruptly in adulthood.
What is testicular torsion?
In testicular torsion, the testicle and spermatic cord twist around their own longitudinal axis. This causes an interruption in the supply of blood to the vessels in the testicle, which means that it no longer receives an adequate supply of oxygen and can die over the course of a few hours. Accordingly, testicular torsion could also be referred to as an infarction of the testis. The extent and severity of the torsion determine how long the testicle can still be supplied with blood without dying. Because the symptoms of testicular torsion can easily be confused with those of acute inflammation of the epididymis, or epididymitis, it should be determined as soon as possible which of the two is really present.
Causes
The main reason that for the most part infants and young children are affected by testicular torsion is due to a relatively rare malformation of the testicular sheaths. These are then not sufficiently fused together, so that even a wrong movement of the child, for example when climbing or riding a bicycle, can be sufficient to cause testicular torsion. Furthermore, an anomaly in the development of the spermatic cord can also promote the occurrence of testicular torsion. However, even without the presence of such malformations, the testis can become unhappily twisted. Often, jerky and unnatural movements during sports or the result of an accident or injury are the triggers. In addition, about half of testicular torsions occur during involuntary movements during sleep.
Symptoms, complaints, and signs
The most prominent symptom of testicular torsion is severe pain on the affected side of the scrotum. These usually occur suddenly and often at night. In rare cases, the discomfort may also be noticed insidiously. In this case, there is a risk of confusion with epididymitis. The pain can radiate over the entire scrotum and subsequently also over the groin area and the lower abdomen. Symptoms are sometimes accompanied by vegetative symptoms such as accelerated heart rate to shock, nausea, vomiting, and dizziness. There may also be prominent redness at the affected site. The testicle often swells and may be prominent. In some cases, there are initially multiple incomplete torsions in which the affected testicle turns back on its own. Symptoms therefore occur only briefly and then disappear. Affected infants experience abdominal pain, umbilical colic, refusal to feed, and motor restlessness. They usually refuse to be calmed down. Testicular torsion is not easy to diagnose in them because it often begins insidiously. Testicular torsion is also difficult to recognize in patients with undescended testicles. They may experience diffuse symptoms that can resemble those of appendicitis.
Diagnosis and course
Testicular torsion is manifested by a severe pain, usually quite sudden, in the testicular and groin areas, which may radiate to the abdomen. Often the abdominal pain even becomes so severe that nausea and vomiting may occur. The affected testicle usually stands up, swells, and the scrotum becomes flushed. In infants, on the other hand, the progression is often more gradual and does not manifest itself nearly as strongly and clearly. Therefore, in crying babies who cannot be calmed down, one should take the precaution of having a testicular torsion ruled out by a pediatrician. Since these symptoms may also indicate inflammation of the epididymis, a urologist should be consulted immediately to determine the exact nature of the condition. Testicular torsion can be diagnosed very quickly by examining the lower abdomen as well as the groin area. Furthermore, it is checked whether the pain is aggravated by lifting the testicle. In addition, an examination of the testicle with ultrasound is usually performed to find out to what extent there is still circulation of blood. If left untreated, testicular torsion often leads to the death of the affected testicle within hours.
Complications
Testicular torsion is usually associated with extremely severe pain for the patient. In this case, the pain occurs even after the torsion and may continue to cause loss of consciousness. During loss of consciousness, the affected person may injure himself by falling. The testicles usually also swell and turn red. Furthermore, the pain from testicular torsion spreads to the other areas of the body, limiting the person’s movement. Abdominal pain may also occur. It is not uncommon for patients to also suffer from vomiting and nausea. Testicular torsion can be treated by surgical intervention. However, this surgery is only possible if the testicle has not completely died. If complete death occurs, no further treatment is possible and it must be removed. Further symptoms usually do not occur. However, if death does occur, this can lead to an inability to conceive, which is not infrequently associated with psychological discomfort. The production of hormones may also be restricted by testicular torsion.
When should you go to the doctor?
If testicular pain is noticed after an accident or fall, testicular torsion may be present. This is a medical emergency, so the affected person should consult a doctor immediately. If the symptoms are severe, the affected person must be taken to the nearest hospital. Typical warning signs that require immediate clarification are severe pain radiating to the groin and a visible reddening of the testicle, often associated with nausea and vomiting. In babies, testicular torsion is often manifested by abdominal pain and umbilical colic. If these symptoms are noticed, medical advice is needed. This is especially true if the symptoms are due to a specific cause, such as a bicycle accident or a fall while climbing. The affected person should immediately talk to their family doctor or a urologist. The emergency medical service can indicate first aid measures and help the affected person with the next steps. Because untreated testicular torsion can cause permanent damage in some circumstances, it is important to respond quickly.
Treatment and therapy
Once testicular torsion has been diagnosed beyond doubt, immediate emergency surgery of the testicle is inevitable. There is no other way to save the affected testicle from dying in time. If the testicle has not yet died, it is immediately rotated back into its original and natural position so that it can be supplied with sufficient blood again. Subsequently, both the affected and the healthy testicle are fixed to the scrotum to prevent renewed testicular torsion. If it is too late to restore the original position and the twisted testicle is already dead, it must at least be removed and the remaining healthy testicle sutured to the scrotum to prevent recurrence of torsion in this testicle as well. The removed testicle can then be replaced with a silicone implant. The ability to conceive, as well as the production of hormones, is usually guaranteed even with only one remaining testicle.
Outlook and prognosis
Testicular torsion usually begins with mild pain but quickly worsens. Affected patients usually take only a few days to see a doctor on their own because of the pain. Because testicular torsion involves a lack of blood flow to a part of the body, it can quickly become a life-threatening condition if left untreated. If testicular torsion is not noticed in time, then the affected testicle will die, releasing toxins that can increase to the point of blood poisoning. On the other hand, if the condition is detected early, then it may still be possible to save the testicle by surgical intervention. If too much damage has already occurred, the twisted testicle must be removed, but the other remains and the patient thus remains fertile. When a testicle is removed, a prosthesis is inserted, of which the patient notices little. It ensures that the scrotum continues to look the same from the outside. If both testicles are affected by torsion, the patient may well lose his fertility during the vital surgical procedure, depending on the progress of the disease. Of course, an attempt is always made to preserve the testicle as much as possible.In addition, the patient is informed about possible complications and subsequent damage before the surgical procedure.
Prevention
The absolutely most important thing when testicular torsion is suspected is prompt diagnosis and treatment. Consequently, if you experience the symptoms described above, you should immediately see a urologist or go directly to the hospital, as every minute can be precious. Prevention is not directly possible.
Aftercare
In most cases of testicular torsion, few or no measures of direct aftercare are available to the patient. The affected individual must have this complaint treated by a physician in the first instance to avoid further complications or discomfort. In some cases, the twisting of the testicle can lead to infertility in the process. Therefore, a doctor should be contacted at the first signs of this complaint. In some cases, surgical intervention is necessary if a testicle has died. The operation itself usually proceeds without complications. Afterwards, the affected person should rest and take care of his body. The activity that led to the twisting of the testicle should be avoided. If this complaint leads to male infertility, some patients need psychological treatment. Talking with one’s family or partner can be very helpful and prevent depression or other psychological upsets. The life expectancy of the affected person is not reduced by this disease, if it is detected and treated early enough.
What you can do yourself
There are no self-help measures in case of complete testicular torsion. Under no circumstances should you try to move the testicle back into the correct position with your own hands or even other aids if you suspect a torsion. Calling an emergency physician is more appropriate. In the common case of partial torsion of the testicle, which may regress and cause pain, it may help to loosely position the testicle afterwards. Excessive warming or cooling, which promises help with pain, is critical in the area of the testicles. These react extremely sensitively to temperature fluctuations – among other things with a movement by the corresponding musculature. This can worsen a partially existing torsion, which is why a visit to the doctor is preferable here as well. If testicular torsion has occurred and has been surgically corrected, it is important to keep the testicle well supported for the time being. Special testicular benches and special sitting pads, can help in everyday life, reduce the risk of occurrence of pain and facilitate the healing process. Moderate cooling is appropriate. People who fear that their testicular torsion will severely limit their ability to conceive should be provided with appropriate information. Knowing that even with one testicle, the ability to conceive is still available will still help in the case of a removed testicle due to testicular torsion.
