From the Guidelines
Testicular torsion is a medical emergency requiring immediate surgical intervention, and symptoms include sudden, severe pain in one testicle, swelling of the scrotum, nausea, vomiting, abdominal pain, and one testicle appearing higher than the other or positioned abnormally, as reported in the most recent study 1. The pain may come on during physical activity, after an injury, or even during sleep. If you experience these symptoms, go to the emergency room immediately as treatment must occur within 4-6 hours to save the testicle.
Key Symptoms
- Sudden, severe pain in one testicle
- Swelling of the scrotum
- Nausea
- Vomiting
- Abdominal pain
- One testicle appearing higher than the other or positioned abnormally The definitive treatment is surgical detorsion (untwisting) and orchiopexy (fixing the testicle to the scrotum wall) to prevent recurrence, as stated in 1. Both testicles are typically secured during surgery since the anatomical defect that allows torsion often affects both sides.
Diagnostic Considerations
- Torsion of a testicular appendage
- Epididymoorchitis
- Epididymitis
- Idiopathic scrotal edema
- Hydrocele
- Inflammation of the tunica vaginalis
- Trauma
- Testicular tumors
- Epididymal cysts
- Fournier gangrene
- Scrotal abscess
- Strangulated inguinal hernia While waiting for medical care, manual detorsion can be attempted by a medical professional, but this is temporary and surgery is still necessary, as mentioned in 1. Testicular torsion occurs when the spermatic cord twists, cutting off blood supply to the testicle, which causes tissue death if not corrected quickly.
Treatment
- Surgical detorsion (untwisting)
- Orchiopexy (fixing the testicle to the scrotum wall) It most commonly affects adolescents and young men but can occur at any age, according to 1. Ultrasound (US) is the established first-line imaging modality for acute scrotal disease and can be used to diagnose most scrotal disorders when combined with clinical history and physical examination, as reported in 1.
Imaging Modalities
- Ultrasound (US)
- Color Doppler US
- Power Doppler US
- Spectral Doppler US
From the Research
Symptoms of Testicular Torsion
- Severe acute unilateral scrotal pain 2
- Nausea and vomiting 2
- High-riding testicle with an absent cremasteric reflex on physical examination 2
- Painful and swollen testis 3
Treatment of Testicular Torsion
- Surgical exploration, detorsion, and orchidopexy for a salvageable testis 4
- Immediate surgical exploration is indicated if history and physical examination suggest torsion, and should not be postponed to perform imaging studies 2
- Prompt recognition and treatment are necessary for testicular salvage 2
- There is typically a four- to eight-hour window before permanent ischemic damage occurs, and delay in treatment may be associated with decreased fertility, or may necessitate orchiectomy 2
Importance of Prompt Diagnosis
- Testicular torsion is a surgical emergency, and delay in diagnosis and treatment can lead to irreversible testicular damage 5
- Prompt diagnosis is essential to prevent complications of testicular torsion, including testicular infarction, necrosis, and sub/infertility 3
- A thorough history, physical examination, and testicular ultrasonography play a vital role in the prompt diagnosis of testicular torsion 3