Testicular Torsion is a common problem related to the male genitourinary tract where a rotation or torsion of the testicles twists the spermatic cord that brings blood to the scrotum. The reduced flow of blood causes intense pain, swelling and inflammation.

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While it can occur at any age and even before birth, it is usually diagnosed in boys between the age of 15-18. It chiefly requires an emergency surgical procedure to save the testicles but in case the blood flow is cut off for a long time, it usually damages the testicles and requires complete removal.

Causes

In general, the testicles are a pair of organs that usually hang in a sac-like structure called the scrotum. This is where testosterone and sperm are made. The blood supply to this organ comes from the spermatic cord, which starts from the abdomen and continues to the scrotum. The cord also contains the vas deferens ( a tube-like structure that brings sperm to the testis). When there is a sudden twist on the spermatic cord, the blood supply to it can get entirely blocked, causing damage more quickly.

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The exact cause of testicular torsion is still not known but most males who get this painful condition have an inherited peculiarity that allows the testicle to rotate freely inside their scrotum, a condition known as the Bell clapper deformity. This inherited condition often affects both testicle balls, but again not every male with this trait will have testicular torsion.

Other secondary causes of testicular torsion can be several hours of vigorous activity, a minor injury to the testicles or even abrupt twisting while in sleep. Sometimes, even cold temperature or rapid growth of the testicle during puberty can cause the spermatic cord to get twisted leading to this condition.

Risk Factors

Certain causative factors that increase the risk of testicular torsion include:

Age: Most commonly diagnosed between ages 12 and 18

Previous Testicular Torsion: A previous testicular pain (intermittent torsion and detorsion) that went away without treatment may recur again

Family History: A genetic history may play a role in developing this condition.

Symptoms

The characteristic signs and symptoms of Testicular Torsion include:

• Sudden, intense pain in the scrotum
• Swelling of the scrotum
• Blood in the semen
• Nausea and vomiting
• Pain in the abdomen
• Fever
• Lump in the scrotal sac
• Higher and unusual positioning of the testicle
• Frequent urination

Complications

If the Testicular torsion is not treated on time, it can cause the following complications:

Damaged Testicle: If the condition is not treated for several hours, the blocked blood supply may permanently damage the testicles and require surgical removal

Male Infertility: In certain cases, damage or loss of the testicle balls may affect a man's capability to father children

Diagnosis And Treatment

If you notice any of the above-mentioned signs and symptoms, do seek medical help at the earliest. The doctor usually does a thorough physical examination of the scrotum, testicles, abdomen and groin, and might slightly rub or pinch the inner side of the thigh on the affected part to check the reflexes. While in normal conditions, the testicles usually contract, in the case of testicular torsion, there is no such reflex.

Other diagnostics to detect this condition includes:

Urine Test: This test is used to detect any infection.

Scrotal Ultrasound: To examine the flow of blood to the scrotum

Surgery: To determine whether the symptoms are caused by testicular torsion or some other condition

Treatment

The treatment of testicular torsion is usually a surgical procedure. While in some cases, the doctor may be able to untwist the spermatic cord by hand, known as Manual Detorsion, a severe twisting of the cord requires a surgery to prevent blockage of blood flow. The surgical repair of testicular torsion is called Orchiopexy.