Testicular Torsion

INTRODUCTION

Testicular torsion is a medical emergency that needs immediate treatment. If treated within 6 hours, there is nearly a 100% chance of saving the testicle. Within 12 hours this rate decreases to 70%, within 24 hours is 20%, and after 24 hours the rate approaches 0. In testicular torsion the spermatic cord that provides the blood supply to a testicle is twisted, cutting off the blood supply.
In most males, the testicles are attached to the inner lining of the scrotum. Males whose attachment is higher up are at risk of testicular torsion. This condition is known as a bell clapper deformity (as in the central piece of a bell) and is a major cause of 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.
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.
Testicular torsion can occur both in childhood and in the adult age with frequency of 1/160 in boys aged between 10 and 25 years old, but it should be considered in all cases where there is a sudden and/or severe testicular pain.

DIAGNOSIS

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.

THERAPY

Surgical exploration may be necessary if diagnosis cannot be made using other methods. If there is the slightest hint of a torsion of the testicle, then doctor will perform surgery; even if the testicle turns out not to have twisted, they will still protect it by attaching the testicle to the scrotum wall.