Testicular Torsion is a medical emergency that occurs when the spermatic cord, which provides blood flow to the testicle, twists and cuts off the testicle’s blood supply. This condition can result from an abnormality in the attachment of the testicle within the scrotum, allowing it to rotate freely. If not treated promptly, testicular torsion can lead to permanent damage or loss of the affected testicle.
Clinical Evaluation
Patient History: Sudden onset of severe testicular pain, history of similar episodes, nausea, and vomiting.
Physical Examination: Swelling, tenderness, and high-riding testicle, with or without an abnormal position (horizontal rather than vertical).
Diagnostic Tests
Ultrasound: Doppler ultrasound to assess blood flow to the testicles. Absence of blood flow indicates testicular torsion.
Urinalysis: To rule out infection or other causes of scrotal pain.
Scrotal Exploration: If clinical suspicion is high, immediate surgical exploration may be performed without prior imaging to save time.
Sudden, severe pain in one testicle.
Swelling of the scrotum.
Nausea and vomiting.
Abdominal pain.
Redness and tenderness of the scrotum.
High-riding or horizontal testicle.
Absent cremasteric reflex (the testicle does not rise when the inner thigh is stroked).
Immediate treatment is crucial to save the testicle. Treatment involves the following steps:
Surgical Intervention:
Emergency surgery (orchiopexy) to untwist the spermatic cord and restore blood flow. The testicle is then anchored to the scrotum to prevent recurrence. If the testicle is nonviable, it is removed (orchiectomy).
Manual Detorsion:
In some cases, an attempt to manually untwist the testicle may be made if surgery is not immediately available. However, this is not a definitive treatment and surgery is still required.
Postoperative Care:
Pain management, antibiotics if needed, and follow-up to ensure proper healing and monitor for complications.