A testicular torsion, i.e. the twisting of the testicles and the associated structures, such as the spermatic cord, is an extremely painful matter. Babies and small children are primarily affected, but testicular torsion can also occur suddenly in adulthood.
What is testicular torsion?
In testicular torsion, the testicles and spermatic cord twist around their own longitudinal axis. This leads to an interruption in the supply to the vessels in the testicles, which means that they are no longer supplied with sufficient oxygen and can die within a few hours. A testicular torsion could therefore also be referred to as an infarction of the testicles.
According to abbreviationfinder, the extent and severity of the twisting determine how long blood can flow through the testicles without dying. Since the symptoms of testicular torsion can easily be confused with those of acute inflammation of the epididymis, i.e. a so-called epididymitis, it should be determined as quickly as possible which of the two is really present.
Causes
The main reason that testicular torsion affects mostly infants and young children is a relatively rare malformation of the testicles.
These are then not sufficiently fused together, so that a wrong movement by the child, for example when climbing or riding a bicycle, can be enough to cause testicular torsion.
An abnormality in the development of the spermatic cord can also promote the occurrence of testicular torsion. But even without the presence of such malformations, the testicle can unhappily twist.
Often, jerky and unnatural movements during sports or the result of an accident or injury are the triggers. About half of testicular torsion also occurs during involuntary movements during sleep.
Symptoms, Ailments & Signs
The most prominent symptom of testicular torsion is severe pain on the affected side of the scrotum. These usually occur suddenly and often at night. In rare cases, the symptoms can only be noticed gradually. There is a risk of confusion with epididymitis. The pain can radiate to the entire scrotum and then to the groin and lower abdomen.
The symptoms are sometimes accompanied by vegetative complaints such as an accelerated heart rate through to shock, nausea, vomiting and dizziness. There may also be a distinctive reddening of the affected area. The testicles often swell and may stand up. In some cases, there are initially repeated incomplete torsions, in which the affected testicle turns back on its own.
Symptoms therefore only appear for a short time and then disappear again. Affected infants experience abdominal pain, umbilical colic, refusal to eat and motor restlessness. Usually they cannot be calmed down at all. Testicular torsion is not easy to diagnose in them, as it often begins insidiously. Twisting of the testicles is also difficult to recognize in those affected with undescended testicles. They can have diffuse symptoms that can resemble those of appendicitis.
Diagnosis & History
Testicular torsion manifests itself as severe pain in the testicles and groin area, which usually occurs very suddenly and can radiate into the abdomen. The abdominal pain often becomes so severe that it can lead to nausea and vomiting.
The affected testicle is usually erect, swollen, and the scrotum becomes red. In infants, on the other hand, the course is often more insidious and is not expressed nearly as strongly and clearly. Therefore, in the case of crying babies who cannot be calmed down, a testicular torsion should be ruled out by the pediatrician as a precaution.
Since these symptoms can also indicate inflammation of the epididymis, a urologist should be consulted immediately to determine the exact nature of the disease. Testicular torsion can be diagnosed very quickly by examining the lower abdomen and groin.
It is also checked whether the pain increases when the testicles are raised. In addition, an ultrasound examination of the testicles is usually carried out to find out to what extent the blood is still circulating. If left untreated, testicular torsion often leads to the death of the affected testicle within hours.
Complications
Testicular torsion is usually associated with extremely severe pain for the patient. The pain occurs even after the torsion and can continue to lead to a loss of consciousness. If the person concerned loses consciousness, he or she may be injured by a fall. The testicles also usually swell and turn red.
Furthermore, the pain from the testicular torsion also spreads to other areas of the body and thus restricts the movement of the person concerned. Abdominal pain can also occur. Not infrequently, the patient also suffers from vomiting and nausea. Testicular torsion can be treated surgically. However, this procedure is only possible if the testicle has not completely died.
Should it die off completely, no further treatment is possible and it must be removed. Other complaints usually do not arise. However, if it should die off, this can lead to infertility, which is often associated with psychological problems. The production of hormones can also be restricted by testicular torsion.
When should you go to the doctor?
If testicular pain is noticed after an accident or fall, testicular torsion may be present. This is a medical emergency and the person concerned should consult a doctor immediately. If the symptoms are severe, the person concerned must be taken to the nearest hospital. Typical warning signs that require immediate clarification are severe pain that radiates to the groin and visible reddening of the testicles, often associated with nausea and vomiting.
In babies, testicular torsion often manifests itself as abdominal pain and umbilical colic. If these symptoms are noticed, medical advice is required. This is especially true if the symptoms are due to a specific cause, such as a bicycle accident or a fall while climbing. The affected person should speak to their family doctor or a urologist immediately. The medical emergency service can name first aid measures and help the person concerned with the further steps. Since untreated testicular torsion can cause permanent damage, a quick response is required.
Treatment & Therapy
As soon as a testicular torsion has been unequivocally diagnosed, immediate emergency testicular surgery is essential. There is no other way to save the affected testicle before it dies.
If the testicle has not yet died, it is immediately turned back into its original and natural position so that it can be supplied with sufficient blood again. Both the affected and the healthy testicle are then fixed to the scrotum to prevent renewed testicular torsion.
If it is too late to restore the original position and the twisted testicle has already died, it must at least be removed and the remaining healthy testicle sewn to the scrotum to prevent the torsion from repeating itself in this testicle.
The removed testicle can then be replaced with a silicone implant. The fertility and the production of hormones are usually guaranteed even if only one testicle remains.
Outlook & Forecast
Testicular torsion usually starts with mild pain that quickly gets worse. Affected patients usually only need a few days before they see a doctor on their own because of the pain. Since testicular torsion is a lack of blood flow to a part of the body, it can quickly develop into a life-threatening condition if left untreated. If a testicular torsion is not noticed in time, the affected testicle dies and thereby releases toxins that can escalate to the point of blood poisoning.
However, if the condition is detected early, it may still be possible to save the testicles through surgery. If the damage is already too great, the twisted testicle must be removed, but the other remains and the patient remains fertile. If a testicle has been removed, a prosthesis is inserted, which the patient hardly notices. It ensures that the scrotum continues to look the same from the outside as before.
If both testicles are affected by torsion, the patient may well lose fertility during the vital surgical procedure, depending on the progress of the disease. Of course, we always try to preserve the testicles as much as possible. In addition, the patient is informed about possible complications and consequential damage before the surgical procedure.
Prevention
The most important thing when it comes to suspected testicular torsion is rapid diagnosis and treatment. Consequently, if you experience the symptoms described, you should immediately consult a urologist or go straight to the hospital, as every minute can be precious. Prevention is not directly possible.
Aftercare
In most cases, if the testicle is twisted, there are few or no direct follow-up measures available to the patient. The person concerned must first and foremost have this complaint treated by a doctor so that there are no further complications or complaints. In some cases, the twisting of the testicles can lead to infertility.
Therefore, a doctor should be contacted at the first sign of this complaint. In some cases, surgery is necessary if a testicle has died. The operation itself usually proceeds without complications. After that, the person concerned should rest and protect his body.
The activity that caused the testicle to twist should be avoided. If this condition leads to male infertility, some patients need psychological treatment. Talking to your own family or partner can also be very helpful and prevent depression or other mental upsets. The life expectancy of the affected person is not reduced by this disease if it is recognized and treated early enough.
You can do that yourself
Self-help measures in the case of a complete testicular torsion do not exist. Under no circumstances should you try to move the testicles back into the correct position with your own hands or other aids if a torsion is suspected. Calling an ambulance is more appropriate.
In the frequently occurring case of partial testicular torsion, which recedes and can cause pain, it can help to position the testicles loosely afterwards. Excessive heating or cooling, which promises relief from pain, is critical in the area of the testicles. These react extremely sensitively to temperature fluctuations – among other things with a movement through the corresponding muscles. This can aggravate a partial rotation that is present, which is why a visit to the doctor is preferable here as well.
If testicular torsion has occurred and is surgically corrected, it is important to position the testicle well for the time being. Special testicle benches and special seat pads can help in everyday life, reduce the risk of pain occurring and facilitate the healing process. A moderate cooling is appropriate. People who fear that their testicular torsion will severely limit their fertility should be given the appropriate information. The realization that fertility is still possible with one testicle also helps in the case of a removed testicle as a result of testicular torsion.
