Testicular Torsion

What is Testicular Torsion?

Testicular Torsion is an emergent condition that requires immediate surgical treatment. The testis and spermatic cord (from which the testis is suspended) twist around themselves over 180o. As the spermatic cord is crossed by arteries, veins, nerves and lymph vessels, any occuring torsion blocks (cuts off) the testicular blood supply; this may lead to testicular necrosis and atrophy if not treated within the first 6 hours. It occurs more often in babies during the1st year of their life and in boys 12-18 years old. In some rare cases it may occur even at a more advanced age. 

What causes Testicular Torsion?

It is more common in boys with cryptorchidism (undescended testes). Other risk factors include injury in the groin or scrotum, intense physical activity. Yet, in most cases, the cause remains unknown (idiopathic or essential).

What are the symptoms of Testicular Torsion?

Symptoms usually occur suddenly. Among them, the most common ones are:

  • Strong testicular pain of sudden onset (if asleep, the patient wakes up because of pain)
  • Pain in the lower abdominal area
  • Νausea and/or vomiting
  • Scrotal redness
  • Scrotal swelling

If the patient is not treated promptly, pain starts subsiding some hours later; however, this is not a good sign because it indicates testicular necrosis.

How is Testicular Torsion diagnosed?

The patient's medical history and physical examination are usually sufficient to set the diagnosis. The problem is how to differentiate from acute orchidoepididymitis (acute inflammation of testis and epididymis) that presents similar symptoms, such as torsion. Colour ultrasound (triplex) of the scrotum is a screening test that can usually confirm the interruption of scrotal perfusion and exclude any inflammation. However, when there is doubt about the diagnosis, a surgical testicular investigation is essential to restore any potential occuring torsion. 

Are there other conditions causing similar symptoms?

There are several conditions presenting similar symptoms to those of testicular torsion. Such symptoms are: 

  • Acute orchitis and epididymitis (orchidoepididymitis) 
  • Scrotal injury
  • Strangulated inguinal hernia
  • Renal colic with pain radiating to the testis
  • Testicular tumours

Should any sudden pain occur in the testes, you should immediately visit your Urologist, who will identify whether it is torsion or any other pathological condition. 

How is Testicular Torsion treated?

Testicular Torsion requires emergency surgery. The scrotum is opened up, the testis-if viable- is reduced and fixated on the scrotum with a suture, in order to avoid any further torsion. If a long period of time passes by, the testis may be necrotized and the physician may decide to remove it. If the torsion is treated within the first 5-6 hours, the results are very good. On the contrary, 12-18 hours later the testis will have been necrotized and has to be removed. In the  inbetween time, testicular viability is estimated by the Urologist in the operation room.