The Taylor&Emmet Blog

Testicular Torsion – Time is of the essence

The testicles are suspended from a cord that is called the spermatic cord. Testicular torsion occurs when the spermatic cord twists and cuts of the blood supply to the testicles. When this happens it causes intense testicular pain to occur in a short space of time.

Testicular Torsion: Who does it affect?

Testicular torsion most commonly occurs in boys just after birth when it is most commonly associated with undescended testicles (1 in 4,000). It can also occur in boys aged 13- 17 years and in men in their 20s and early 30s (approximately 1 case in 25,000 per year for boys up to 25 years old).

Testicular Torsion: Why does it occur?

  • Some boys have a congenital (occurring before birth) defect that allows the testicles to rotate freely and this condition accounts for approximately 90% of all testicular torsion cases.
  • Torsion can also follow a significant trauma to the testicle such as an accident or an injury to the testicles.
  • Testicular torsion can also happen without any reason and it is vital that it is treated urgently.

Testicular Torsion: What are the Symptoms?

The patient presents with pain in the testicles that are extremely tender. The pain is sudden, severe and the patient usually has a feeling of sickness and occasionally is sick as a result.

Testicular Torsion: Diagnosis

A patient should attend Accident and Emergency as soon as possible. Generally, the quicker a patient attends hospital and a diagnosis is made, the sooner treatment can be given or surgery can be performed if necessary, which gives a greater chance of saving the testicle. A physical examination will be performed.
If the diagnosis is unclear a Doppler ultrasound scan is the most effective way of diagnosing a testicular torsion.

Testicular Torsion: Treatment

What is important in testicular torsion is receiving treatment or surgery promptly. With a quick diagnosis and the patient receiving treatment swiftly the testicle can often be saved. If torsion cannot be excluded, then patient should undergo urgent surgical intervention by way of an exploratory operation. It has been noted that survival and preservation of the testicle after 8 hours of torsion is extremely unlikely. Figures indicate that when a patient with a twisted testicle receives surgery within 6 hours of testicular torsion 9 out of 10 twisted testicles are saved, however beyond 24 hours following a torsion, only 1 out of 10 that are found to be twisted will be preserved1.

Most patients are either referred urgently by their GP to their nearest hospital, or they attend hospital via Accident and Emergency. Most present with pain that has been in the testicles for less than 24 hours. Patients usually go straight to hospital in cases of testicular pain largely due to the severity of the pain and the symptoms of the torsion itself causing serious concern.

The testicle must be untwisted by a medical professional as quickly as possible to try and preserve it, so far as it can be. Torsion can result in the loss of fertility and further if not treated soon enough the testicle will be more than likely have to be completely removed to avoid further damage to the remaining testicle.

There are some methods of conservative treatment a surgeon may take to untwist the testicle manually but, in most cases if there is a loss of blood flow and ongoing pain the only way to be sure that the testicle is untwisted is via surgical exploration.

Time is certainly of the essence in diagnosing and treating a patient with testicular torsion to give them the best possible outcome.

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Sources
1 http://www.nhs.uk/Conditions/Testicular-lumps-benign/Pages/Treatment.aspx
Wikipedia
http://www.baus.org.uk/Regions/north-west/publications

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