From the Research
Introduction to Testicular Torsion
Testicular torsion (TT) is a medical emergency that occurs when the spermatic cord becomes twisted, cutting off the blood supply to the testicle [ 1 ]. This condition requires prompt diagnosis and treatment to prevent permanent damage and infertility.
Causes and Risk Factors
The exact cause of testicular torsion is not always clear, but it is often associated with a condition called "bell-clapper" deformity, where the testicle is not properly attached to the scrotum [ 1 ]. This deformity can cause the testicle to twist more easily, leading to torsion. Testicular torsion can occur at any age, but it is most common in adolescent males.
Preventive Measures
There are no proven preventive measures for testicular torsion, but early recognition and treatment of the condition can help prevent long-term damage [ 2 ]. Males with a history of testicular torsion or those with a family history of the condition should be aware of the symptoms and seek medical attention immediately if they experience any pain or discomfort in the testicles.
Signs and Symptoms
The symptoms of testicular torsion can vary, but common signs include:
- Sudden and severe pain in the testicle
- Swelling and redness of the scrotum
- Nausea and vomiting
- Abnormal testicular position, such as a high-riding testicle
- Absent cremasteric reflex [ 2 ]
Diagnosis
Diagnosis of testicular torsion is typically made based on a combination of physical examination, medical history, and imaging studies such as Doppler ultrasound or radionuclide scintigraphy [ 1, 2 ]. The whirlpool sign, which is a twisting of the spermatic cord, is a specific ultrasonographic feature that can indicate testicular torsion [ 3, 4 ].
Treatment
Treatment for testicular torsion typically involves surgical intervention to restore blood flow to the affected testicle [ 1, 2 ]. Manual detorsion, which involves manually rotating the testicle to restore blood flow, can be attempted in some cases, but surgical exploration is often necessary to confirm the diagnosis and prevent recurrence [ 3, 4 ]. The use of point-of-care ultrasonography can help guide manual detorsion and improve the success rate of the procedure [ 3, 4 ].
Complications and Long-term Effects
If left untreated, testicular torsion can lead to permanent damage and infertility [ 1, 5 ]. Even with prompt treatment, some males may experience long-term effects such as abnormal semen analysis and decreased fertility [ 1 ]. Ischemic postconditioning has been proposed as a potential therapeutic treatment to prevent adverse effects of ischemia-reperfusion injury after testicular torsion-detorsion [ 5 ].
Differential Diagnosis
Testicular torsion can be difficult to diagnose, and other conditions such as epididymitis and torsion of the appendix testis should be considered in the differential diagnosis [ 2 ]. A thorough physical examination and imaging studies can help distinguish between these conditions and confirm the diagnosis of testicular torsion.