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Johns Hopkins Symptoms and Remedies

Johns Hopkins Medicine

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Testicular Torsion

What is it?

The testicle is suspended within the scrotum by the spermatic cord. Each cord, in addition to providing a conduit for sperm manufactured in the testis, contains blood vessels that supply the testicle. Testicular torsion involves an abnormal twisting of a testicle and its spermatic cord, so that testicular blood supply is cut off (strangulation). The condition is extremely painful, and if prompt treatment is not obtained, permanent damage may occur within hours, rendering the affected testicle unable to produce sperm. In 90 percent of cases, torsion involves only one testicle; sperm production still occurs in the unaffected testicle, and fertility persists despite a diminished sperm count. In rare cases the testicle somehow becomes untwisted by itself, resulting in immediate relief. Subsequent evaluation by a physician is essential nonetheless, so that recurrence can be prevented and more serious disorders, including testicular cancer, may be ruled out. Testicular torsion is most common between the ages of 12 and 18, although it can happen at any age, including infancy.

What Causes It?

  • Testicular torsion usually occurs spontaneously for no apparent reason; indeed, it may even occur during sleep.
  • The patient may be predisposed to the condition because of a congenital abnormality or weakness in the structures within the scrotum.
  • Torsion sometimes occurs following very strenuous activity.

Prevention

  • Testicular torsion is difficult to anticipate and thus difficult to prevent; in any case, use an athletic supporter when engaged in strenuous physical activities.

Diagnosis

  • Patient history and physical examination suggest the diagnosis. Because testicular torsion is an emergency, treatment is generally initiated at once, without any special tests.
  • An ultrasound scan may be done to rule out other disorders (such as epididymitis or strangulated hernia) that produce similar symptoms.
  • Diagnosis is confirmed by visual inspection of the twisted spermatic cord during the minor surgical procedure used to correct testicular torsion.

How to Treat It

  • Immediate medical treatment is imperative. The doctor will first attempt to properly reposition the testicle by gentle manipulation.
  • If manipulation fails, a small incision is made in the scrotum and the testicle is rotated to untwist the spermatic cord.
  • In most cases—whether torsion is corrected by manipulation or surgery—the testicle is surgically anchored to the side of the scrotum (orchiopexy) to prevent recurrences. As a precaution, the unaffected testicle may be anchored in place too.
  • If treatment is not received soon enough (within a few hours), the testicle begins to atrophy and may have to be removed (orchiectomy).

When to Call a Doctor

  • EMERGENCY Get immediate medical attention for any severe testicular pain or injury. Even if the pain eases on its own, the likelihood of recurrence or complications warrants examination by a doctor.