Testicular Torsion
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| Testicular Torsion |
Testicular torsion is a medical emergency that occurs when the testicle twists around the spermatic cord, which contains the blood vessels that supply it. This twisting cuts off the blood flow to the testicle, causing severe pain and potentially leading to permanent damage if not treated promptly.
Symptoms:
- Sudden and severe pain in the testicle.
- Swelling and redness in the scrotum.
- Nausea and vomiting.
- Pain that may radiate to the abdomen.
- In some cases, the testicle may appear in an abnormal position within the scrotum.
Causes:
- Congenital abnormality: Known as the "bell-clapper deformity," where the testicle is more prone to movement within the scrotum.
- Sudden activity or trauma to the area.
- In some cases, torsion can occur without an identifiable cause.
Diagnosis:
- Clinical examination: A doctor evaluates the pain and the position of the testicle.
- Doppler ultrasound: Used to assess blood flow to the testicle.
- In emergencies, surgery may be performed without additional tests to save time.
Treatment:
Emergency surgery:
- Untwisting the testicle to restore blood flow.
- Fixing (orchiopexy) both testicles to prevent future torsion.
- If treatment is delayed, removal of the damaged testicle (orchiectomy) may be necessary.
Timing is critical:
- Treatment within six hours of symptom onset gives the best chance of saving the testicle.
- Delay increases the risk of permanent damage.
Prevention:
If you have a family history of the condition or have experienced torsion before, a doctor may recommend preventive surgery to fix the testicles.
If you experience similar symptoms, it is crucial to go to the emergency room immediately.
How can we identify testicular torsion through touch?
Testicular torsion can be suspected through manual examination (touch) if the person experiences symptoms like sudden severe pain, but there are specific signs that help distinguish it from other conditions like epididymitis. However, a definitive diagnosis requires professional medical evaluation and possibly ultrasound imaging.
What you might feel during touch:
Severe pain on touch:
Pain is sharp and sudden.
Does not improve with changes in the testicle's position or body movement.
Position of the testicle:
The affected testicle may be higher than the other one in the scrotum.
The testicle may be in a horizontal or tilted position instead of its normal vertical position.
Swelling and firmness:
The scrotum may appear swollen.
The testicle may feel firm due to lack of blood flow.
Prehn’s Sign:
In testicular torsion: Lifting the testicle does not relieve the pain (or may worsen it).
In epididymitis: Lifting the testicle relieves the pain.
Spermatic cord:
In some cases, you may feel the twisted spermatic cord as an abnormal or tense mass.
Important note:
Avoid excessive pressure or manipulation of the testicle as it may worsen the condition. If the symptoms suggest testicular torsion, seek immediate emergency care.
Definitive diagnosis:
Diagnosis cannot rely on touch alone.
Doppler ultrasound is essential to evaluate blood flow to the testicle.
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| Testicular Torsion |
Does testicular torsion cause epididymitis?
Typically, testicular torsion and epididymitis are separate conditions with distinct causes and mechanisms. However, in rare cases, untreated torsion or mild, recurrent torsion can lead to changes in blood flow and localized inflammation, potentially causing secondary inflammation in the epididymis or surrounding tissues.
The relationship between testicular torsion and epididymitis:
Differences in causes:
Testicular torsion: Caused by the twisting of the spermatic cord, cutting off blood flow, and is a medical emergency.
Epididymitis: Often caused by bacterial infections (such as urinary tract infections or sexually transmitted infections) or non-infectious inflammation.
Similarities in symptoms:
Both conditions can cause pain and swelling in the scrotum.
This similarity may complicate diagnosis without proper testing.
Chronic or delayed cases:
If torsion is left untreated, it may lead to chronic inflammation in surrounding tissues, potentially including the epididymis.
Secondary inflammation may occur due to tissue necrosis (death) caused by prolonged blood flow interruption.
