Testicular torsion is a condition that involves twisting of the testicle. In turn, this causes the spermatic cord from which it is attached to also twist, leading to loss of blood flow to the testicle and scrotum. The lack of blood supply presents an immediate risk. If left untreated for more than a few hours, testicular torsion can lead to loss of the testicle, tissue damage, or decreased fertility. The main treatment for this condition is surgery to prevent further damage to the testicle and to keep torsion from reoccurring.
The cause of testicular torsion is unknown, but it may arise if the testicle or the protective sac around the testicle is not completely attached to the scrotum, allowing it to move around freely. Often times, this is the result of a congenital defect. The condition may also be inherited or occur after injury to the scrotum or testicle.
Factors That Affect Treatment for Testicular Torsion
Some form of intervention is needed within six hours of the start of pain to prevent long-term damage to the testicle and its loss. The type of treatment depends upon whether the testicle is partially or completely twisted. More severe torsion requires more urgent treatment. The patient's age, health, and medical history may also determine the best course of treatment.
In some cases, untwisting the testicle without surgery may be possible, although swelling and pain in the scrotum makes this unlikely. Surgery is the usual method for treating testicular torsion. It may also be used to diagnose the condition, followed by immediate untwisting of the testicle if it is present.
Surgery for Testicular Torsion
The main goal of surgery is to untwist the testicle in order to restore the flow of blood. At the same time, the testicle will also be surgically fixed in place to prevent torsion from occurring again.
During surgery, the doctor will make an incision in the scrotum and the covering of the testicle. The spermatic cord is then untwisted. The testicle is also attached to the inner wall of the scrotum using sutures.
Before the scrotum is closed with stitches, the surgeon will check the color and blood flow to the affected testicle to make sure the surgery was successful.
If the testicle shows signs of tissue death (necrosis), the surgeon may remove the testicle (orchiectomy). This is done to prevent long-term pain and tenderness.
To improve the physical appearance of the scrotum following orchiectomy, a fake testicle (prosthesis) may be placed inside the scrotum at this time. This procedure is sometimes delayed for six months to allow time for the testicle and scrotum to heal completely.
Outcome and Prognosis
Delaying treatment for testicular torsion can lead to:
- Death of tissue in the testicle
- Complete loss of the testicle
- Infection
- Infertility caused by loss of the testicle
- Cosmetic deformity
The severity of the damage depends upon whether the testicle was partially or completely twisted. Earlier emergency treatment also increases the chance of saving the testicle. When treatment is provided within six hours of the start of pain, 90 to 100 percent of testicles can be saved. This drops to less than 10 percent when the wait time is over 24 hours.
References
Dajusta DG, Granberg CF, Villanueva C, et al. (2012). Contemporary review of testicular torsion: New concepts, emerging technologies and potential therapeutics. J Pediatr Urol 9(6):723-30.
Kar A, Ozden E, Yakupoglu YK, et al. (2010). Experimental unilateral spermatic cord torsion: the effect of polypolymerase enzyme inhibitor on histopathological and biochemical changes in the early and late periods in the ipsilateral and contralateral testicles. Urology 76(2):507.
Schneck FX, Bellinger ME. (2007). Abnormalities of the testis and scrotum and their surgical management. Campbell-Walsh Urology. 9th ed.
