What is testicular torsion?

Quick Answer
A twisting or rotation of the testicle (testis) or spermatic cord on its long axis, causing acute pain and swelling.
Expert Answers
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Causes and Symptoms

Testicular torsion is most commonly found in infants, adolescents, or young adult males. Roughly half of the cases occur in the early hours of the morning, and cases usually occur on the left side rather than the right. The condition can occur during sleep, rest, game playing, or hard physical activity, but it is more likely to be caused by direct injury. Testicular torsion may also result if the testicle is unusually mobile within its covering in the scrotum because of inadequate connective tissue.

Testicular torsion makes itself known by pain of varying degrees either in the lower part of the abdomen or in the scrotum itself. The pain intensifies rapidly and is occasionally accompanied by nausea as the testicle becomes swollen and very tender and the scrotal skin becomes discolored. A diagnosis can be made by physical examination.

Treatment and Therapy

Immediate treatment of testicular torsion is necessary. The testicle must be untwisted immediately and blood flow restored to the testicle, the epididymis, and other structures. Otherwise, complete blockage of the blood supply (ischemia) for six hours or more may result in gangrene (tissue death) of the testicle. Even a partial loss of circulation can produce atrophy.

Manual untwisting should be followed by surgery within six hours of the onset of symptoms to ensure that the torsion has been undone successfully and that there is no recurrence. An incision is made in the scrotal skin, and the testicle is secured to the scrotum by small stitches. If irreversible damage has been done, the testicle must be removed. The other testicle, which usually remains capable of producing active sperm, is also anchored to prevent torsion on that side. Prompt surgery generally ensures a complete recovery.

Bibliography:

Behrman, Richard E., Robert M. Kliegman, and Hal B. Jenson, eds. Nelson Textbook of Pediatrics. 19th ed. Philadelphia: Elsevier/Saunders, 2011.

Montague, Drogo K. Disorders of Male Sexual Function. Chicago: Year Book Medical, 1988.

Rajfer, Jacob, ed. Urologic Endocrinology. Philadelphia: W. B. Saunders, 1986.

Rifkin, Matthew D., and Dennis L. Cochlin. Imaging of the Scrotum and Penis. Florence, Ky.: Taylor & Francis, 2002.

Swanson, Janice M., and Katherine A. Forrest. Men’s Reproductive Health. New York: Springer, 1984.

Taguchi, Yosh, and Merrily Weisbord, eds. Private Parts: An Owner’s Guide to the Male Anatomy. 3d ed. Toronto: McClelland & Stewart, 2003.

“Testicular Torsion.” Urology Care Foundation, Jan. 2011.

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