Testicular Torsion

In testicular torsion, the spermatic cord twists with the rotation of a testis or the mesorchium (the mesentery between the testis and epididymis), strangulating the testis. It occurs unilaterally about 90% of the time. Testicular torsion is most common in males ages 12 to 18 (although it can occur at any age). With early detection and prompt treatment, the prognosis is good.

Causes

Some men may be predisposed to testicular torsion as a result of inadequate connective tissue within the scrotum. However, the condition can result from trauma to the scrotum, particularly if significant swelling occurs. It may also occur after strenuous exercise or may not have an obvious cause.

The condition is more common during infancy (first year of life) and at the beginning of adolescence (puberty).

Signs and Symptoms

• Symptoms include the following:

  • Blood in semen
  • Lower abdominal pain
  • Lump in testicle
  • Nausea and vomiting
  • Sudden, severe testicular pain, followed by diminishing pain after several hours (after necrosis begins to set in)
  • Redness of scrotum
  • Swelling of one testicle

Diagnostic tests

Doppler ultrasonography helps distinguish testicular torsion from strangulated hernia, undescended testes, and epididymitis.

Testicular scan using technetium tc 99m pertechnetate allows a definitive diagnosis.

Treatment

A vascular emergency, testicular torsion must be treated within 4 hours of initial pain. Treatment consists of immediate surgical repair by orchiopexy (fixation of a viable testis to the scrotum) or orchiectomy (excision of a nonviable testis). Analgesics relieve pain postoperatively.

Prevention

Epididymitis and orchitis are frequently, but not always, associated with sexually-transmitted diseases.

There are no special preventive measures for testicular torsion. Paying attention to symptoms, and getting early diagnosis and treatment may prevent loss of a testicle.