Testicular torsion is a condition when the testes twist around the spermatic cord. The spermatic cord contains all the blood vessels that supply the testes. The twisting of the spermatic cord compresses the blood vessels and cuts off the blood supply to the testes. This increases the risk of death of testicular tissue. Emergency diagnosis and treatment is required in order to salvage the testes. A congenital malformation of the testes known as “bell-clapper deformity” increases the chances of torsion of the testes. It presents as a sudden onset pain in the scrotal region and severe tenderness locally. It is mainly a clinical diagnosis. However in some cases ultrasonography may be helpful to confirm the diagnosis. On examination the cremasteric reflex is decreased or absent. The presentation usually mimics the pain of epididymitis.
Risk factors for torsion: Certain congenital conditions increase the chances of testicular torsion. Bell clapper deformity is a deformity of the processus vaginalis and is the most common congenital deformity predisposing to testicular torsion. In this condition there is a deformity in the attachment of the testes to the scrotum. The size of the testis is another predisposing factor. A larger testicle is more prone to undergo torsion than a one that is smaller in size. Torsions are most commonly seen in winter season. The cold temperature outside causes the spermatic cord to suddenly contract and twist upon it. It is most commonly seen in adolescents between 12 to 18 years of age.
Symptoms and signs of testicular torsion: Sudden onset severe pain in one or both the testicles following a predisposing event. Pain is accompanied with faintness, nausea or vomiting. A swelling in the scrotal region is seen. On examination the cremasteric reflex is typically absent. The testicle on the affected side is higher in position and there is extreme tenderness on palpation. A Doppler ultrasound scan may be done in order to confirm the diagnosis.
Treatment of the torsion: Prompt diagnosis and treatment is most important in managing cases of torsion of the testes. In some cases the testicle may untwist on its own or it can be manually untwisted and restored to its original position. Pain relief may first be given before attempting manual detorsion.
Testicular torsion is a surgical emergency requiring immediate intervention. If treated within 6 hours there is an excellent chance of about 90 % to save the testicle. Over 24 hours the testicle is dead in most cases and is prone to gangrenous infection and hence must be removed immediately. Within 12 hours the rate of saving the testicle drops down to 50 %, within 24 hours to 10 % and after 24 hours to zero. One must remember that the other testicle too bears a high chance of undergoing torsion in the future. Hence, during surgery it is best that the other testicle is ligated and fixed to the scrotum in order to prevent all further chances of testicular torsion of the other testicle.
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