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Testicular Torsion

Overview

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Testicular torsion is a medical emergency that occurs when the spermatic cord, which supplies blood to the testicle, becomes twisted. This twisting cuts off the blood supply to the testicle, leading to potential tissue damage or loss if not treated promptly. It most commonly affects males between the ages of 12 and 18 but can occur at any age.

This twisting cuts off the blood supply to the testicle, leading to potential tissue damage or loss if not treated promptly. It most commonly affects males between the ages of 12 and 18 but can occur at any age.

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Symptoms
  • Sudden Severe Pain: Often in one testicle, which may radiate to the abdomen or groin.
  • Swelling: Enlargement of the affected testicle or scrotum.
  • Nausea and Vomiting: Often accompanying the pain.
  • Abnormal Position: The affected testicle may appear higher or in an unusual position in the scrotum.
  • Redness or Darkening: The skin over the scrotum may appear red or darker.
Complications

If not Treated Quickly, Testicular Torsion can Lead to:

  • Testicular Necrosis: Death of the testicular tissue due to lack of blood supply.
  • Infertility: Loss of the affected testicle may impact future fertility, especially if the other testicle is also compromised.
  • Chronic Pain: Some patients may experience ongoing discomfort even after treatment
Causes

The Exact Cause of Testicular Torsion is Often Unclear, but Several Factors may Contribute:

  • Anatomical Factors: A condition called the "bell clapper deformity," where the testicle is not attached securely to the scrotum, allowing for greater mobility.
  • Trauma: Injury to the testicle may trigger torsion.
  • Physical Activity: Sudden movements or strenuous exercise can sometimes lead to torsion.
  • Previous Episodes: A history of torsion increases the risk of recurrence.
Prevention

While not All Cases of Testicular Torsion can be Prevented, Some Measures may Help Reduce Risk:

  • Surgical Intervention: In cases of undescended testicles or previous torsion, a surgical procedure (orchidopexy) can secure the testicles and prevent future occurrences.
  • Education: Raising awareness about the symptoms of torsion can lead to quicker medical intervention.
Risk Factors

Factors that Increase the Likelihood of Testicular Torsion Include:

  • Age: Most common in adolescent males but can occur at any age.
  • History of Torsion: Previous episodes increase the risk of recurrence.
  • Family History: Genetic predisposition may play a role.
  • Undescended Testicles: Males with this condition are at higher risk.
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How is it treated?

Testicular Torsion is a Surgical Emergency and Requires Immediate Treatment:

  • Surgery (Detorsion and Fixation): The primary treatment involves untwisting the spermatic cord and securing the testicle in place to prevent recurrence.
  • Pain Management: Analgesics may be administered to alleviate pain during and after the procedure.
  • Monitoring: Postoperative monitoring is essential to ensure proper recovery and function of the testicle.
  • Prompt diagnosis and treatment are crucial in minimizing complications and preserving testicular function. If someone experiences sudden testicular pain, it’s important to seek emergency medical care immediately.
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How is it Diagnosed?

Testicular torsion is a urological emergency in which the spermatic cord twists, cutting off blood supply to the testis. Prompt diagnosis is vital to prevent irreversible damage. Clinical history and physical examination are critical first steps. Patients typically present with sudden, severe scrotal pain, swelling, nausea, and sometimes vomiting. The affected testicle may appear elevated or have a horizontal lie, and the cremasteric reflex (a reflexive elevation of the testis upon stroking the inner thigh) is usually absent.

Color Doppler ultrasound is the imaging modality of choice. It assesses blood flow to the testicles—reduced or absent flow is highly suggestive of torsion. However, if clinical suspicion is very high, surgical exploration should not be delayed for imaging, as time is a critical factor for testicular salvage.

Additional differential diagnoses such as epididymitis or torsion of a testicular appendage must be ruled out based on age, onset of symptoms, and imaging findings. Urinalysis may be done to rule out infection, though it is usually normal in torsion. Ultimately, diagnosis is confirmed during surgical exploration, where detorsion and orchiopexy (surgical fixation) are performed. If the testis is non-viable, orchiectomy may be necessary.

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