Testicular Torsion

Overview

Testicular torsion is a medical emergency that occurs when the spermatic cord, which provides blood flow to the testicle, twists and cuts off the testicle’s blood supply. This condition causes sudden and severe pain and swelling and can lead to permanent damage or loss of the testicle if not treated promptly. Testicular torsion most commonly affects adolescents and young men but can occur at any age.

The first documented case of testicular torsion dates back to ancient times, although the exact etiology and pathophysiology were not well understood until the 20th century. Advances in medical imaging and surgical techniques have significantly improved the diagnosis and treatment of this condition.

Causes

Testicular torsion occurs when the spermatic cord twists, cutting off the blood supply to the testicle. This can happen due to:

Bell-Clapper Deformity: A congenital condition where the testicles are not properly attached within the scrotum, allowing them to move more freely and increasing the risk of twisting.

Injury: Trauma to the testicles or scrotum.

Physical Activity: Sudden movements or strenuous activities may trigger torsion.

Cold Temperatures: Exposure to cold can sometimes cause the testicle to retract and twist.

Risk Factors

Several factors can increase the risk of testicular torsion:

• Age: Most common in males between 12 and 18 years old.
• Previous Torsion: A history of testicular torsion increases the risk of recurrence if it was not previously corrected with surgery.
• Family History: A family history of testicular torsion may increase susceptibility.
• Undescended Testicle (Cryptorchidism): Testicles that have not descended properly may have an increased risk of torsion.

Complications

If not treated promptly, testicular torsion can lead to severe complications:

Testicular Loss: Prolonged lack of blood flow can cause tissue death, necessitating removal of the testicle.

Infertility: Damage or loss of the testicle can affect sperm production and fertility.

Chronic Pain: Persistent pain or discomfort in the affected area.

Infection: Increased risk of infection if the testicle is damaged or removed.

Prevention

While it may not be possible to prevent testicular torsion entirely, certain measures can help reduce the risk:

• Awareness: Educating at-risk individuals, particularly adolescents, about the symptoms of testicular torsion and the importance of seeking immediate medical attention.
• Surgical Fixation: For individuals with a history of torsion or known anatomical risk factors, elective orchidopexy can be performed to secure the testicles and prevent future episodes.
• Early Presentation: There is only about 6 hours from onset of pain until some irreversible loss of testicle function/tissue occurs. If you are concerned your child may have testicular torsion, do not delay in presenting them at an Emergency Department of a major hospital (with a pediatric surgery and/or urology service) for urgent evaluation.