Testicular Torsion: Diagnosis and Treatment

If you have signs and symptoms of testicular torsion, it’s important to seek immediate medical care to determine if torsion is the cause of your pain or swelling. Since testicular torsion is a surgical emergency, most tests performed by your doctor will be used to rule out that diagnosis or confirm it.

In the physical examination, the doctor will assess your cremasteric reflex. This is a reflexive response to rubbing the inside of the thigh on the affected side. It should produce testicular contraction, but the reflex is absent in most men with testicular torsion.

Testicular Torsion Diagnosis

An important diagnostic test for testicular torsion is an ultrasound examination of the blood flow to the testicles. Since torsion obstructs the blood supply, decreased blood flow on ultrasound exam is a reliable sign of the condition. In some cases, however, the ultrasound examination may not be adequately sensitive to pick up reductions in blood flow, so a normal examination does not rule out the diagnosis. If your ultrasound is normal but you continue to have signs and symptoms associated with torsion, you may require surgery to determine if your symptoms are the result of testicular torsion or another disorder.

Infants can experience testicular torsion and because they are unable to communicate their symptoms, there are several important signs for parents to notice. In an infant, the testicle may appear swollen, hard, or dark in color. Some male infants have signs and symptoms of testicular torsion at birth, and although there are some risks to surgical procedures in this age group, emergency surgery can often result in sparing of the testicle and prevention of torsion in the other testicle. The testicles produce testosterone, which is critical for development in men, in addition to production of sperm, which is an important factor in fertility.

Testicular Torsion Treatment

Treatment for testicular torsion begins with manual detorsion attempts. The doctor will initially attempt to untwist the affect testicle without surgery, but men with torsion will require surgery to prevent another occurrence. If manual detorsion doesn’t work, then surgery is the only effective treatment. Patients with testicular pain that has lasted several hours are often taken directly to surgery without additional testing, in order to reduce the risk of loss of the testicle.

Surgery for repair of testicular torsion is performed under general anesthesia, in most cases. During surgery to correct testicular torsion, the surgeon will make a small incision in the scrotum and untwist the spermatic cord. The surgeon will also fasten one or both testicles in place to prevent another episode. If surgery begins within 6 hours of the initial episode of pain, there is only a five percent risk of losing the testicle. This risk increases dramatically. If surgery is delayed more than forty-eight hours, most men will lose the testicle.

Be alert for any unusual pain or swelling in the scrotum. If it occurs, it’s important to determine if testicular torsion is the cause. If you are the parent of a young boy, be aware that they may not be able to communicate their symptoms, but it remains important to be alert in order to preserve fertility and production of male hormones.