An Unkind Twist of Fate-Testis Torsion

There are very few surgical emergencies in medicine but one of them is torsion of the testicle. Testicle torsion is caused by the twisting of the spermatic cord, which causes a loss of blood flow to the testicle and a lack of life-sustaining oxygen to the testicular tissue. Torsion is the most common cause of testicle loss in adolescent males.
Causes
The cause of the majority of cases is the result on not having the testicle anchored to the bottom of the scrotum. As a result the testicle is allowed to twist more easily, resulting in compromise of the blood supply to the testicle. This can occur spontaneously or may be associated with blunt trauma to the testicle. This anatomic defect is present in both testicles.

Normal testis on left and torsion on the right

Torsion of the testis with loss of blood supply and oxygen to the testicle


Symptoms
Testicular torsion is characterized by excruciating one-sided testicular pain with sudden swelling. Men may also have nausea and vomiting.
Testicular torsion is seen most frequently in the 12-18-year-old age group, and most cases occur in men under 30 years of age. However, it can occur at any age, including in newborns.
Getting help
Testicular swelling and pain should be evaluated immediately. The diagnosis is easily made with a scrotal ultrasound. Once the diagnosis of torsion is confirmed, immediate surgery is indicated. There is about a six-hour window for the testicle to be salvaged; surgical treatment within this time frame is associated with a 100% salvage rate for the testicle. After six hours, the salvage rate decreases, and if surgical repair is performed after 24 hours, the testicle is no longer salvageable. The surgeon, usually a urologist, will untwist the spermatic cord and which will improve the blood supply to the testis. The testis is then anchored to the bottom of the scrotum and the opposite testicle is also surgically secured to the bottom of the scrotum since the condition frequently affects both testicles.
Bottom Line: Testicle torsion is a surgical emergency. With early diagnosis the testicle can be saved by surgically securing the testicle to the bottom of the scrotum.

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