What Is Testicular Torsion

Torsion is a term used in medicine which simply means twisting. Testicular torsion is an emergency condition which results from the twisting of the cord which supplies blood to the testis.
In biological males, the scrotum contains the testicles; this is the male reproductive organ. They are responsible for producing sperm and sex hormones such as testosterone. 

Testicles are connected to the abdomen via a cord called the spermatic cord, which contains blood vessels, nerves, lymphatic vessels and the Vas Deferens (a tube delivering sperm to the testis).¹ Often times, these cords can twist, which results in the blood supply being cut off to the testis; this phenomenon is known as Testicular torsion.
The next sections will discuss an in-depth overview of testicular torsion; including answering some commonly raised questions about the causes,  risks, complications of testicular torsion, and when to seek medical advice.

Overview

Testicular torsion is an acute medical emergency which requires immediate medical intervention. The testicles, which are an integral part of the male reproductive system, are responsible for producing male sex hormones essential for the maintenance of normal hormonal levels and as well as giving them the ability to reproduce. Towards the later stages of fetal development in male foetuses, the testicles are covered by a membrane known as ‘Tunica Vaginalis’. The Tunica Vaginalis is a layer that is a part of the abdominal covering, known as the peritoneum. The testicles descend from the abdomen down to the skin sac known as the scrotum.¹ Within the scrotum, the testicles are connected by a cord known as the ‘Spermatic cord’, which supplies the testicles with blood and nerves as well as drains lymphatics. This spermatic cord is further connected to the abdominal vessels passing through the inguinal region.² When this spermatic cord twists, the blood supply to the testicles is cut off, resulting in an extremely painful condition, which in the world of medicine is known as testicular torsion.³ While other conditions, such as infection or testicular cancer, can cause some degree of pain and discomfort, testicular torsion is a medical emergency that requires immediate medical intervention. The reason behind this phenomenon is that an emergency arises due to the testicles no longer receiving an oxygen supply (from the blood), which may cause permanent testicular damage. Thereby, testicular damage may result in the sexual organs no longer being viable for its function.

Causes of testicular torsion

Torsion can happen at any age and time, even whilst one is asleep.³ A few known causes are listed below:

• ‘Bell Clapper’ deformity. This is a condition that causes the testicles within the scrotum to move freely in the sac. This affliction affects some individuals, while others may have their testicles anchored to the scrotum base.
• Any injury to the scrotum or testis.
• Vigorous exercise.

Signs and symptoms of testicular torsion

Signs:

• Swollen and red scrotum
• A positive Prehn's sign (when pain does not subside even after elevating the scrotum)

Symptoms:

• Acute unbearable pain
• Unusual pain in the abdomen
• Fever
• The position of the testicle is higher than usual.
• Frequent urination
• Nausea and vomiting^3,4

Management and treatment for testicular torsion

Following a positive diagnosis of testicular torsion, there is a need for immediate emergency surgery to untwist the spermatic cord to return the blood supply to the testis. 

This surgery, also known as orchidopexy, occurs under anaesthesia whereby the surgeon untwists the spermatic cord, after which the testicles are observed for a positive blood supply to the tissues. The testicle and cord are then stitched to the base of the scrotum using an absorbable suture. This ensures the future prevention of torsion. Oftentimes, the unaffected testicle is stitched in the same manner to prevent torsions.³

Diagnosis

The diagnosis of testicular torsion is made clinically by healthcare professionals by observing the patient's scrotum for positive signs (such as a positive Prehn's sign). Scans such as scrotal ultrasound have limited diagnostic value and mostly depend on the attending doctor's decision.³

Risk factors

A few risk factors associated with a higher risk of developing testicular torsion are as follows: 

• Age: Testicular torsion occurs most commonly within the 12-18 years. It mainly occurs under the age of 25.⁵
• Family history: A positive family history of the condition can be a risk factor in developing the disorder.
• History of previous testicular torsion: The risk of testicular torsion increases manyfold if the individual has had a previous history of testicular torsion.³

Complications

The most common complication of testicular torsion is the loss of the viability of the testis. Delays in surgery can cause the tissue of the testis to die due to the loss of blood supply. This can cause impotence in the future, affecting the ability to produce offspring.

Further complications can also arise following surgery, such as scrotal swelling, although this does generally subside over time. Infection is also another common complication in the case of surgery, which also requires treatment with antibiotics.^3,4

FAQs

How can I prevent testicular torsion

Being aware of the implications and its signs is the most common way to prevent testicular torsion. If an individual has had a previous history of torsion as well as a family history, they should consult with a urologist to check whether their testicles have the ‘Bell Clapper’ deformity. 

Furthermore, any sudden severe pain, even hours after exercise and minor trauma should be taken seriously.³

How common is testicular torsion

Testicular torsion is a rare phenomenon which exclusively affects one testicle. It occurs in about 1 in 4000 men under the age of 25.⁵

When should I see a doctor?

Any sudden severe pain, redness, or swelling in the scrotum accompanied by nausea, fever and problems in urination, which cause an individual a significant amount of discomfort, should prompt one to seek medical advice immediately.³

Summary

Testicles are an integral part of the male reproductive system. They not only allow males to reproduce, but they also maintain the normal function of the male hormones within the body. 

Testicular torsion, albeit a rare phenomenon, is an emergency condition which requires immediate medical management. While the thought of surgery can be daunting among certain individuals, they shouldn’t delay in seeking treatment as it can cause the loss of the viability of the testicle. Surgical interventions are treated as a day case, and individuals are allowed to go home after making a full recovery once they wake up from being under anaesthesia.

Moreover, if an individual has a previous history of torsion and a positive family history, they should be aware and have a consultation with their GP to rule out any further episodes of testicular torsion. If treated within the timeframe, one can prevent the loss of their testicle which allows them to have full function and control of their reproductive system.