Testicular torsion is a serious, painful, emergency condition.  Testicular torsion is when the spermatic cord that provides blood flow to the testicle twists and cuts off blood supply.  This usually requires emergency surgery to correct.  Most of the time only one testicle is affected, but it is not unheard of for it to affect both at the same time. 

If left untreated permanent damage, or even testicular death can occur.  Getting treatment within 4-6 hours of the onset of symptoms, almost everyone keeps their testicle.  Treatment after 12 hours about half keeps the testicle.  Only 10% keep their testicle if treatment doesn’t happen within the first 24 hours.  

Testicular torsion affects men of all ages.  About 65% of all cases occur in men between the age of 12 and 18 years old.  It is an uncommon condition only affecting one in every 4000 men under the age of 25 years old.  Men who have bell clapper deformity are at a higher risk of having testicular torsion.  Bell clapper deformity is a condition that causes a man to not have the tissue to hold the testicles in place, which can make it easier for them to become twisted.  Most of the time testicular torsion happens spontaneously, meaning there is no known cause as to why it has happened.  It can happen after strenuous exercise, injury to the area, while you sleep, or after a growth spurt brought on from puberty. 


The first symptom that usually presents itself is sudden and severe pain in one testicle.  The pain may radiate up to your stomach.  Which can cause you to feel nauseous.  You may have symptoms like nausea, vomiting, and abdominal pain.  Swelling in the scrotum can also occur.  Discoloration of the scrotum, red or blue, can also occur.  Lumps in the scrotum can be another symptom.  Other symptoms include one testicle being higher than the other, blood in semen, fever, frequent urination, and pain being so painful that you have difficulty walking. 


Testicular torsion usually brings you into the emergency room due to the symptoms and pain.  The doctor will listen to your signs and symptoms.  They will want to do a physical exam to see if there is any swelling, discoloration, or lumps in the scrotum.  Urine tests and blood tests can be done to check for infections and make sure your pain isn’t being caused by something else.  Imaging may also be done.  Sometimes this can be an ultrasound to check for blood flow.  Your doctor may want to do a CT scan to make sure there is no other cause for your pain depending on your symptoms.  It can be hard for patients to know where their pain is originating from especially if it radiates up into your stomach.  This can make it easy for your doctor to not suspect testicular torsion right away.  Testicular torsion is more common on the left side, which can radiate pain up into your left abdomen.  This can make you suspect an appendicitis. 


In some cases testicular torsion can untwist on its own.  If this happens your pain will decline.  But you will still want to seek medical attention.  Testicular torsion can reoccur if left untreated.  The main treatment for testicular torsion is emergency surgery.  The surgery is an orchiopexy.  It takes about 45 minutes to complete.  As the patient you will be under general anesthesia, so you will be asleep and not know what is happening during the surgery.  The surgery is minimally invasive.  In most cases you do not have to stay in the hospital after surgery.  You will be released shortly after your surgery is completed and you stay in recovery for a few hours.  During the orchiopexy your surgeon will make a tiny incision in the scrotum.  After that they will untwist the spermatic cord.  After the cord is untwisted your surgeon will stitch the testicles to the inside of the scrotum to prevent the cord from becoming twisted again.  Surgery will help stop recurrence, but surgery is never done for prevention.  If the testicle is too damaged during surgery, the surgeon will remove it.  

After surgery you will most likely be allowed to go home.  Over the counter pain medications can be used if you have pain from the surgery.  Ice packs can be used to help reduce swelling.  It is important to keep your surgical incision clean.  Wash with warm soapy water.  Dissolvable stitches are usually used for this procedure so you won’t need to get stitches removed after the surgery.  Your doctor will probably want you to avoid physical activity that might injure the area.  Don’t ride a bike for about a week.  No sports for 4-6 weeks.  No heavy lifting, or straining.  


Complications that can occur are infection if the testicle is dead and not removed, or at the incision site if not kept clean.  Infertility can occur.  In some cases lower sperm count can occur in people who have suffered from testicular torsion.  Cosmetic deformity if the testicle has to be removed.  Atrophy of the testicle can also happen.  This happens when the testicle shrinks because it is not treated right away, which can in turn lower sperm count.  Testicular death is the worst complication.  Getting treatment quickly can minimize these complications.  


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