Testicular torsion

Diagnosis

Testicular torsion can be diagnosed by a healthcare provider based on your symptoms, medical history, testicular examination, and scrotal ultrasound.

• Physical examination: In order to confirm if testicular torsion is the cause of your symptoms or something else, your healthcare provider will question you. Physical examinations of the scrotum, testicles, abdomen, and groin are frequently used by healthcare providers to identify testicular torsion.

Additionally, your healthcare provider may lightly press or pinch the inside of your thigh on the side that is affected to assess your reflexes. Usually, this results in the testicle contracting. If you have torsion in your testicles, this response might not happen.

• Scrotal ultrasound: Blood flow is monitored using this kind of ultrasonography. Testicular torsion is indicated by decreased blood flow to the testicle. However, testicular torsion may not always be ruled out by ultrasound since the diminished blood flow is not always visible.
• Urine test: This examination looks for infections.
• Surgery: To rule out other conditions or testicular torsion as the cause of your symptoms, surgery may be required. 

You may be sent straight to surgery without further testing if your physical examination indicates that you have testicular torsion and you have been in pain for several hours. If surgery is postponed, testicle loss may occur.

Treatment

Testicular torsion must be corrected surgically. In some cases, the healthcare provider may be able to do a manual detorsion—pressing on the scrotum—to untwist the testicle. However, surgery will still be required to keep the torsion from happening again.

Testicular torsion surgery is called orchiopexy. This is often performed under general anesthesia. The healthcare provider will make a little incision in your scrotum during the procedure, untwist your spermatic cord if required, and stitch one or both testicles to the inside of the scrotum. 

The testicle has a better chance of survival the sooner it is untwisted. There is an increase in the likelihood of requiring testicle removal six hours after the pain first appears. If treatment is delayed for more than 12 hours after the onset of pain, there is at least a 75 percent chance that removal of the testicle will be necessary. 

Although it’s uncommon, testicular torsion can happen to newborns and infants. The testicles of the baby may be firm, enlarged, or have a darker hue. Surgery might be required to confirm testicular torsion since ultrasound may not be able to identify decreased blood flow to the infant’s scrotum.

The management of infant testicular torsion remains a topic of debate. When symptoms and signs of testicular torsion are present in a newborn, the use of general anesthesia poses risks, and emergency surgery may not always be immediately feasible. Nevertheless, urgent surgical intervention, when possible, can potentially salvage part or all of the affected testicle and prevent damage to the other testicle. Early treatment of newborns with testicular torsion may help prevent future complications related to male hormone production and fertility.