Testicular Torsion: A Urological Emergency

Introduction

• Definition: Testicular torsion occurs when a testicle rotates, twisting the spermatic cord, which reduces blood flow to the scrotum.
• Age of Occurrence: Most common between ages 12-18, but can occur at any age, even before birth.
• Family History: Can run in families.
• Emergency: Requires emergency surgery to save the testicle and prevent fertility issues.

Symptoms

• Sudden, severe pain in the scrotum.
• Swelling of the scrotum.
• Abdominal pain, nausea, vomiting, potential fever.
• Testicle may be higher or at an unusual angle.
• Often occurs in young boys at night or early morning.

Importance of Seeking Medical Care

• Immediate Attention: Seek emergency care to prevent severe damage or loss of the testicle.
• Twisting and Untwisting: Even if pain subsides, medical evaluation is necessary.

Causes

• Spermatic Cord Rotation: Blocks blood flow if twisted multiple times.
• Inherited Trait: Allows testicle to rotate freely; may affect both testicles.
• Triggers: Vigorous activity, minor injury, sleep, cold temperatures, rapid growth during puberty.

Diagnosis

• Medical History & Physical Exam: Inspection of scrotum, testicles, abdomen, and groin.
• Reflex Testing: Pinching inner thigh to check if testicle contracts and moves upward.

Treatment

• Emergency Surgery: Required to save the testicle.
  • Procedure:
    • Incision in the scrotum.
    • Untwist testicle, observe blood flow.
    • Fix testicle in place with stitches to prevent future torsion.
    • Check other testicle; fix in position to prevent opposite side torsion.
    • Close incision with dissolvable stitches.

Surgery Risks

• Infection, hematoma, potential future loss of testicle, long-term scrotal pain.

Post-Operative Care

• Pain Management: Regular painkillers (e.g., paracetamol) for a few days.
• Supportive Underwear: Wear supportive brief-style pants or scrotal support for comfort.
• Rest: Rest at home, take a week off school/work.
• Activity Restrictions: Avoid swimming (7-10 days) and strenuous activities (3-4 weeks).
• Wound Care: Keep clean and dry; showers after 2 days, baths after 5 days.
• Monitor for Complications: Contact medical team if feeling unwell, fever, increased pain, or discharge.

Prevention and Monitoring

• Regular Self-Exams: Monthly check for lumps or changes in testicles.
• Consult Doctor: If any abnormalities are found.