Testicular torsion

 ICD10       = N44 |
 ICD9        = 608.2 |

}} In testicular torsion the spermatic cord that provides the blood supply to a testicle is twisted, cutting off the blood supply, often causing orchalgia. Prolonged testicular torsion will result in the death of the testicle and surrounding tissues.

In most males, the testicles are attached to the inner lining of the scrotum. Males who do not have this natural attachment are at risk for testicular torsion. A male who notices the ability of either or both testicles to freely rotate within the scrotum should be aware that he is at risk of testicular torsion. Testicles that are in a much lower position and/or in a slightly rotated position in the scrotal sack are a visual indicator of this risk.

While torsion is more frequent among adolescents, it should be considered in all cases where there is testicular pain. Torsion occurs more frequently in patients who do not have evidence of inflammation or infection.

Testicular torsion is a medical emergency that needs immediate treatment. After 6 hours there is about 12% chance of saving the testicle, and after 8 hours it's not possible to save it. Once the testicle is dead it must be removed to prevent gangrenous infection. Emergency testing for torsion may be indicated when the onset of pain is sudden and/or severe, or the test results available during the initial examination do not enable a diagnosis of urethritis or urinary tract infection to be made. A doppler ultrasound scan of the scrotum, if available, is of immense help in the diagnosis by showing the presence or absence of blood flow to the testicle. Dizziness and nausea are often present when there is an absence of blood supply to the testicle. If the diagnosis is questionable, an expert should be consulted immediately, because testicular viability may be compromised. If physical examination suggests a compromised blood supply and the patient has had such symptoms for a significant period of time, medical personnel may choose to bring the patient directly to surgery without an ultrasound since the time required for ultrasound testing could affect testicular viability. With prompt diagnosis and treatment the testicle can be saved in a high number of cases (see references below).

A simple surgery will correct and prevent testicular torsion. It can be done in an emergency situation after determination that the testicle is cut off from blood supply or as an outpatient procedure for patients who have experienced frequent episodes with testicular torsion. If necessary, the surgeon will first untwist the testicle(s). The surgeon will then permanently suture the testicles to the inner lining of the scrotum. If only one testicle has been problematic, the surgeon will still suture both testicles as a preventative effort.

It is also believed that torsion occurring during foetal development can lead to the so-called neonatal torsion or vanishing testis, and is one of the causes of an infant being born with monorchism.

Torsions are sometimes called "winter syndrome". This is because they often happen in winter, when it is cold outside. The scrotum of a man who has been lying in a warm bed is relaxed. When he arises, his scrotum is exposed to the colder room air. If the spermatic cord is twisted while the scrotum is loose, the sudden contraction that results from the abrupt temperature change can trap the testicle in that position. The result is a testicular torsion.

External links

Adapted from the public domain document Centers for Disease Control and Prevention. 1998 Guidelines for Treatment of Sexually Transmitted Diseases. MMWR 1998;47(No. RR-1) at http://wonder.cdc.gov/wonder/STD/STD98TG/STD98T12.HTM and other sources.

• Arce JD, Cortes M, Vargas JC. Sonographic diagnosis of acute spermatic cord torsion. Rotation of the cord: a key to the diagnosis. Pediatr Radiol. 2002 Jul;32(7):485-91. Epub 2002 Apr 10.
• Cattolica EV, Karol JB, Rankin KN, Klein RS. High testicular salvage rate in torsion of the spermatic cord. J Urol. 1982 Jul;128(1):66-8.