Testicular torsion is the twisting around of the spermatic cord. The spermatic cord is a structure in males, that is formed by the vas deferens (likewise known as the vas deferens), and surrounding tissue that travels from the deep inguinal ring down to each testicle. The cord suspends the testicle. In a situation where the testicle rotates, it twists the cord supplying blood to the scrotum (which is a loose bag of skin that holds the testes) beneath the penis. The twisting of the spermatic cord is described as Testicular torsion.
Testicular torsion is a disorder that is very common in newborns, before and during puberty. It happens in about one per 4,000 to 25,000 males under the age of 25 years each year. Testicular torsion is one of the major causes of testicular pain in children.
Testicular torsion can cause severe pain, swelling, and heaviness in the testicular region. It should be treated as an emergency because the longer you wait to seek treatment, the higher the risk of permanent testicle damage.
Predisposing Factors And Causes Of Testicular Torsion:
- Testicular tumor
- Prior trauma involving the testicles
- Bell-clapper deformity (is a congenital malformation of the processus vaginalis)
- Cold temperature
- Vigorous physical activity, for example, bicycle riding
- The horizontal line of the testicle
- A spermatic cord with an extended intrascrotal portion
- Cryptorchidism (undescended testes: A testicle that hasn’t moved into the bag of skin below the penis before birth)
Classification Of Testicular Torsion:
There are five types of testicular torsion, they are:
- Intermittent testicular torsion (ITT): is a less severe form of testicular torsion. It is characterized by temporary scrotal or testicular pain, followed by spontaneous detorsion and relief of pain.
- Intravaginal torsion: occurs when the testicle rotates on the spermatic cord within the tunica vaginalis.
- Extravaginal torsion: is the type of testicular torsion that occurs outside of the tunica vaginalis. It is more common in newborns.
- Torsion of the undescended testes.
- Torsion of the testicular appendix.
Symptoms Of Testicular Torsion
Here are the signs and symptoms of testicular torsion:
- Sudden, severe pain in the testicles, groin region, and lower abdomen.
- Pain that worsens when the testicles are moved.
- Unusually high testicles in the scrotum
- Vomiting (very common in young children)
- Testicular swelling and heaviness
- Mild warmth and redness overlying the testicular region
- High body temperature (fever)
How is Testicular Torsion Diagnosed?
Diagnosis is confirmed with an ultrasound, while urine analysis is used to detect any present infection.
How is Testicular Torsion Treated?
- Physically untwisting the testicle
- Surgery: the surgical procedure done depends on the state of the testes. If complications have set in, removal of the testes is carried out.
- Opioids are used to relieve the pain
The outcome of treatment depends on the time of correction. It is successful when it is treated within six hours of onset. However, if delayed for 12 or more extra hours, the testicle is usually not recoverable, so quick treatment is the best way to save the testicle from permanent damage. Approximately 40% of people require the removal of the testicle.
What happens if you don’t fix testicular torsion?
If testicular torsion not treated, it can cause the following complications:
- Permanent testicle damage
- Testicular infarction: due to decrease blood supply to the testicles
- Male Infertility
- Depression (due to the psychological effect of losing a testis)
- Testicular gangrene
- Recurrence of testicular torsion may happen after initial surgical fixation