From the Guidelines
Testicular constriction, also known as testicular torsion, is a medical emergency requiring immediate attention, and if suspected, one should go to the emergency room immediately as surgery within 6 hours of symptom onset offers the best chance of saving the testicle. Symptoms of testicular torsion include sudden, severe scrotal pain, swelling, nausea, and vomiting. While waiting for medical care, over-the-counter pain medications like ibuprofen (400-600mg) or acetaminophen (500-1000mg) can be taken for temporary relief, but this should not delay seeking emergency treatment 1. It is crucial not to attempt to manipulate or "untwist" the testicle yourself. The condition occurs when the spermatic cord twists, cutting off blood supply to the testicle, which can lead to tissue death within hours.
Key Points to Consider
- Risk factors for testicular torsion include anatomical abnormalities like the "bell-clapper deformity" where the testicle isn't properly attached to the scrotum 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 1.
- US findings in testicular torsion may include an enlarged heterogeneous testis, ipsilateral hydrocele, skin thickening, and no color Doppler flow in the testis or spermatic cord 1.
- After treatment, wearing supportive underwear and avoiding high-impact activities for several weeks may be recommended to prevent recurrence.
Diagnostic Approaches
- The use of color Doppler, power Doppler, and spectral Doppler US can help evaluate testicular perfusion and differentiate between testicular torsion and other conditions like epididymoorchitis 1.
- The "whirlpool sign" on US, which refers to a spiral twist of the spermatic cord, is a specific sign of torsion 1.
- Newer techniques like microvascular imaging US and shear wave elastography (SWE) may offer additional diagnostic capabilities, especially in challenging cases or when conventional methods are inconclusive 1.
From the Research
Testicular Constriction
There is no direct evidence of testicular constriction in the provided studies. However, the studies discuss testicular torsion, which is a related condition.
Testicular Torsion
- Testicular torsion is a twisting of the spermatic cord and its contents, affecting 3.8 per 100,000 males younger than 18 years annually 2.
- It is a surgical emergency that requires prompt recognition and treatment to prevent testicular loss due to ischemia 2, 3.
- Patients typically present with severe acute unilateral scrotal pain, nausea, and vomiting, and physical examination may reveal a high-riding testicle with an absent cremasteric reflex 2.
- Delay in treatment may be associated with decreased fertility or may necessitate orchiectomy 2.
- Testicular torsion is a clinical diagnosis, and immediate surgical exploration is indicated if history and physical examination suggest torsion 2.
- Salvage rates exceed 90% when surgical exploration is performed within 6 hours of symptom onset 3.
Diagnosis and Management
- A thorough history, physical examination, and testicular ultrasonography play a vital role in the prompt diagnosis of testicular torsion 4.
- The cremasteric reflex and testicular sonography are frequently used, yet imperfect, diagnostic tools in assessing for testicular torsion 5.
- Prompt diagnosis is essential to prevent complications of testicular torsion, which include testicular infarction, necrosis, and sub/infertility 4.