Testicular Torsion

In some men, the tissue surrounding the testicle is not well attached to the scrotum. This makes it easy for the testicle to become twisted around the spermatic cord. If not treated, the tissue of the testicle may die. This problem is more common at puberty. This is because the testicles grow to 5 or 6 times their previous size during this period.

Symptoms of this condition often include:

• sudden pain and swelling in the scrotum
• reddening of the skin of the scrotum
• testicle lying higher and horizontally in the scrotum
• lower abdominal distress
• nausea and vomiting
• in infants, irritability or restlessness

Torsion of one testicle may indicate that a man is at higher risk for the same condition on the other side. This is because the defect that makes it possible for the testicle to twist is often present on both sides. This condition can sometimes be due to testicular cancer that causes the testicle to increase dramatically in size.

In most cases, this condition cannot be prevented. If a man has torsion of one testicle and surgery is done, the other testicle is often anchored into place to prevent it from developing torsion in the future.

The diagnosis of testicular torsion is based primarily on a physical exam and a man's medical history. A painful, swollen scrotum makes a healthcare professional suspect this condition. In some cases special x-ray tests, most commonly a sonogram of the scrotum, can be helpful to make sure other conditions, such as infection, are not the cause of the symptoms.

If the blood supply is not restored within 6 hours of torsion, permanent tissue damage is likely. The entire testicle may be destroyed. Therefore, immediate surgery is critical if this condition is present.

There are no risks to others because this condition is not contagious.

Testicular torsion repair surgery is always needed to treat this condition, if it does not quickly go away on its own. To begin the operation, local anesthesia is given in the affected area. Other pain or relaxing medication may also be given to make the man comfortable.

A cut is then made in the scrotum. If the healthcare professional suspects a testicular cancer as the cause, the cut may be made in the groin. The testicle is brought out and the cord is untwisted. The testicle is observed to see if normal color returns. This indicates that blood flow is returning. Next, the other testicle is secured to the scrotum with a few stitches. This procedure is called orchiopexy and helps prevent torsion in the future.

The first testicle is then re-examined to see if it is recovering properly. If it appears that permanent tissue damage has taken place, the testicle is removed. If the organ has recovered, it is secured with stitches to the scrotum as well. If a testicular lump suspicious for cancer is identified, the testicle is most commonly removed regardless of its recovery.

The scrotum often swells significantly after surgery. Blood may collect in the scrotum following surgery. As with all surgery, there is a small risk of infection. Reaction to any pain medications is also possible.

The man should rest as much as possible after surgery. Keeping the scrotum elevated can help reduce discomfort. Pain medications and ice packs may also be prescribed to reduce pain. Rarely, the attempt to secure the testicle is unsuccessful and the testicle can twist a second time.

After recovery from surgery, no further monitoring is generally needed. Affected men who have similar symptoms in the future should seek immediate treatment at the nearest emergency room. Quick treatment of torsion has a much higher chance of saving the affected testicle.