There are several problems that can affect the male reproductive system. Testicular torsion is one of them. It occurs when the testicle gets rotated and twists the spermatic cord. The twisted spermatic cord partially or completely cuts off blood flow to the testis. It gives rise to sudden and agonizing pain in the groin and lower abdomen together with vomiting.
The highest incidence of testicular torsion is between ten and twenty five years of age. The second most common age period is during infancy. Testicular torsion is a surgical emergency. The main aim is to restore the blood supply to the testis.
Early diagnosis and management is the key to save the affected testis. All males under this age group who have acute scrotal pain should be ruled out of having testicular torsion.
Causes Of Testicular Torsion
Male reproductive system is made up of internal and external reproductive organs. Male testis is an external reproductive organ; other organs include scrotum, epididymis and semeniferous tubules in the testes. Sperm is produced in testis. The testis is attached with a tube like structure called spermatic cord. Sperm passes through the spermatic cord to be released through the glance.
Spermatic cord consists of blood vessel which supplies blood to the testis. When spermatic cord gets twisted due to rotation of testis this blood supply is hampered. It may lead to severe testicular damage. In many cases the exact reason for testicular torsion is not known, however following are believed to be the predisposing factors:
- An injury to the scrotum. Example, a kick on the scrotum, a softball or a base ball hitting a man on the scrotum.
- There may be an underlying hereditary trait.
- Too much straining during bowel movement, lifting heavy weight and excessive maneuver of scrotum during sex by the partner is all believed to be the exciting causes.
- Occasionally the risk of torsion increases during sleep.
- Extreme cold temperature
- Rapid growth of scrotal structures during pubertal age.
- Vulnerable age is during infancy and between 10 to 25 years.
Signs And Symptoms Of Testicular Torsion
The symptoms may vary with the degree of torsion present.
- There is intense and severe pain in the scrotum and lower abdomen.
- Pain develops suddenly
- Swelling of testis and scrotum. It becomes red initially but gradually becomes blue if there is complete loss of blood supply.
- Pain is often one sided. It is more felt on the affected side testis.
- In traumatic injury to the scrotum, there may be a history of dizziness and fainting.
- The affected side of the testis remains higher in the scrotum as the spermatic cord shortens due to twisting. It is a specific finding which indicates testicular torsion.
Treatment For Testicular Torsion
Testicular torsion is considered to be a medical emergency. Prompt diagnosis helps to save the complete damage of testis. Doppler study and clinical examination are important to diagnose the condition quickly.
The main aim is to restore the blood supply in the affected testis. The first 4 to 6 hours are critical to save the testis. Therefore surgery should be considered immediately once the diagnosis is made. During surgery the spermatic cord in untwisted and the blood flow to the testicle is restored. Both testicles are then stitched in the scrotum to prevent recurrence of testicular torsion.
During first hour of torsion, some doctors do attempt to untwist the testis with gentle maneuvering. If it is successful, the pain is relieved. If untwisting is achieved, it may remove the urgency, but at the same time surgery should be done as quickly as possible.