Testicular torsion is one of the most critical urological emergencies, a painful condition that, if not treated quickly, can result in the loss of the affected testicle. Knowing its symptoms, causes, and the need to act quickly can make the difference between saving or losing a testicle. Therefore, in this article, you will find a comprehensive guide to understanding this medical emergency, from its basics to its long-term implications.
Reservation your first medical consultation now
and discuss your case with one of our medical specialists, no strings attached.
What is testicular torsion?
It's an emergency medical condition that occurs when the testicle twists, twisting the spermatic cord that supports it. This cord contains the blood vessels (testicular artery and vein), nerves, and the tube that carries semen. When it twists, blood flow to the testicle is interrupted.
Ischemia (lack of oxygen and nutrients) begins to damage testicular tissue within hours. If blood flow is not restored quickly, the tissue dies and the testicle becomes nonviable, requiring removal.
PREMIUM QUALITY
Intravaginal torsion
It is the most common type and usually occurs in adolescents and young men. It occurs within the tunica vaginalis, the serous membrane that covers the testicle. It is common in men who have a congenital abnormality known as "bell-clapper deformity" (bell-clapper deformity), in which the testicle is not properly attached to the scrotum and hangs freely, allowing it to rotate much more easily around the spermatic cord, this condition is present in approximately 12% of men.
Extravaginal torsion
Almost exclusive to newborns and fetuses during the perinatal period, torsion occurs above the point where the tunica vaginalis attaches to the scrotum. Here, torsion involves both the testicle and its coverings (the tunica vaginalis) twisting together. It is often discovered at birth as a swollen, hardened, and discolored scrotum, and the testicle is usually no longer viable at this point.
Causes and risk factors
The direct cause is physical rotation of the testicle. However, there are several risk factors, such as the aforementioned bell-clapper deformity, and age, with the incidence being higher in newborns (extravaginal torsion) and adolescents between 12 and 18 years of age (intravaginal torsion).
There is also a higher risk if there is a previous history of testicular torsion.
Additionally, it can be triggered by trauma to the scrotum or during vigorous physical activity.
A higher incidence has been observed in cold seasons, possibly due to the contraction of the cremaster muscle that elevates the testicle, and it usually occurs at puberty due to the rapid growth during puberty that occurs at this stage.
Symptom
The symptoms of testicular torsion are acute and very characteristic. They appear suddenly and include testicular pain Sudden, severe, and intense pain with the main symptom being swelling of the scrotum, nausea and vomiting in response to the intense pain, abnormal position of the testicle, abdominal pain, low-grade fever in some cases, and a lack of the cremasteric reflex. Normally, stroking the inner thigh raises the testicle on the same side. In torsion, this reflex is often absent.
How long does a testicular torsion take?
Testicular torsion damage is a process measured in hours, and its prognosis depends on the time elapsed from the onset of pain to medical intervention.
In less than 6 hours, the chances of saving the testicle are excellent. The success rate progressively decreases, reaching around 50% after 12 hours. After 12 hours, the chances of saving the testicle are very low (less than 10%). After 24 hours, necrosis is usually complete and irreversible.
How to differentiate epididymitis from testicular torsion?
Epididymitis develops over several hours or days. In adult men, especially with UTIs, it usually presents with high fever, burning when urinating, the cremasteric reflex remains normal, and the pain improves when the testicle is elevated.
In contrast, in testicular torsion, the pain is sudden and severe, occurs mostly in adolescents and newborns, fever is uncommon and low, there are no urinary symptoms, and the cremasteric reflex disappears. Furthermore, the pain does not decrease when the testicle is elevated.
However, any acute testicular pain should be treated as a torsion until proven otherwise by examination and imaging tests.
Medical evaluation and diagnosis
Symptoms are assessed, and the cremasteric reflex and Prehn's sign are checked.
Color Doppler ultrasound allows visualization of blood flow within the testicle. In a torsion, blood flow will be absent or significantly reduced in the affected testicle.
A urinalysis may be required to rule out a urinary tract infection that would suggest epididymitis.
Prognosis and complications
If treated early, the prognosis is excellent and the testicle can fully recover.
However, if treatment is delayed, the patient may experience testicular atrophy, infection of dead tissue (scrotal abscess), loss of the testicle, and infertility problems due to a reduction in sperm count.
Treatment of testicular torsion
The treatment is exclusively surgical and constitutes a medical emergency.
In some cases, the doctor may try to manually untwist the testicle by turning it to the correct side, which may temporarily restore blood flow while the operating room is prepared.
In exploratory orchidopexy surgery, under general anesthesia, the testicle is detwisted and its viability assessed. If the tissue is viable, it is sutured to the inner wall of the scrotum (orchiopexy) to prevent future torsion.
If the testicle is not viable, it is removed to prevent complications.
During the same surgery, and because the "bell clapper" anomaly is usually bilateral, the surgeon always also fixes the healthy testicle to prevent future torsion.
It may interest you: orchiepididymitis.
Reservation your first medical consultation now
and discuss your case with one of our medical specialists, no strings attached.
Does testicular torsion affect sexual life and fertility?
Production testosteroneTestosterone, the hormone responsible for libido and sexual function, is controlled by the testicles. If one testicle is lost but the other is healthy, it usually produces enough testosterone to maintain a normal sex life. There shouldn't be any erection problems.
A single healthy testicle is also capable of producing enough sperm for fertilization. However, in some cases, especially if there was damage to the spared testicle or if the body develops antibodies against the sperm from the damaged testicle, there may be a reduction in sperm quality or quantity.
How to avoid testicular torsion?
There is no sure way to prevent a first testicular torsion, especially if the "bell clapper" anomaly is present. However, orchidopexy surgery (fixation of both testicles) is the only effective way to prevent recurrences after a first episode or in patients with a history of intermittent testicular pain suggestive of spontaneous torsion that resolves on its own.
Frequently Asked Questions (FAQs)
Is it possible to have testicular torsion without knowing it?
Yes, especially in newborns, where it can occur painlessly and be discovered at birth. There may also be cases of intermittent "torsion-detorsion," which causes sharp but temporary pain.
What sleeping positions cause testicular torsion?
There is no scientific evidence linking a specific sleeping position to testicular torsion. Movements during sleep can be a trigger, but not the root cause.
Does testicular pain always mean torsion?
No. There are many causes of testicular pain. However, due to the severity of torsion, any acute testicular pain should be evaluated by a doctor immediately.
Is it possible for it to happen again after surgery?
The risk of a fixed testicle twisting again after surgery is less than 5%.
How long does recovery take after surgery?
Full recovery takes 2 to 4 weeks. It is recommended to avoid strenuous physical activity, contact sports, and heavy lifting for at least 4 to 6 weeks.
What is the probability of testicular torsion?
It is a relatively rare condition. It affects approximately 1 in 4.000 men under the age of 25.
What happens if I lose a testicle?
The loss of a testicle does not significantly affect a man's ability to have an erection, have a satisfying sex life, or have children. The remaining testicle is responsible for producing sufficient testosterone and sperm. A testicular prosthesis can be inserted for cosmetic purposes.
Medical treatments with qualified professionals at Doctor T Clinic
Testicular torsion is a medical emergency that can cause severe pain and, if not treated promptly, the loss of the affected testicle.
En Doctor T Clinics We do not directly treat this type of pathologies, but if you are noticing chronic fatigue, lack of motivation, problems sleeping, or low libido, it is possible that the origin is a hormonal imbalance, such as a testosterone low.
We offer you tools to detect it early and, if necessary, initiate specialized medical treatment:
- Comprehensive health assessments focused on male wellness.
- Online Testosterone Test free, which acts as a first step to detect hormonal problems, such as low testosterone or high testosterone.
- Personalized advice and treatments tailored to individual needs.
- Testicular health education and injury prevention methods.
- Testosterone Replacement Therapy (TRT), indicated in cases of primary hypogonadism o secondary hypogonadism, helps you regain your vitality, sexual energy and overall well-being.
We offer personalized programs for comprehensive male care, aimed at preserving sexual health, reproductive function, and quality of life.
En Low T Center We help you take care of your intimate health. Schedule your assessment and take the first step toward complete male well-being.
Reservation your first medical consultation now
and discuss your case with one of our medical specialists, no strings attached.
Conclusion
Testicular torsion is a medical emergency that requires immediate recognition and swift action, where every minute counts. Knowing its symptoms allows patients and their families to seek medical help immediately. Surgery is a highly effective procedure for saving the testicle and preventing future problems, so if you have the slightest suspicion of symptoms, you should go to the nearest emergency room without delay.
0 comments