Introduction
Testicular torsion is where a testicle twists inside the scrotum due to the spermatic cord twisting. The spermatic cord supplies blood (and therefore oxygen) to the testicle and when it is twisted this supply is cut off. If this occurs it is very important to receive urgent medical attention as the testicle may become unviable within hours, and need to be removed.
Testicular torsion is relatively rare (affecting ~.025% of males under 25) and mainly affects teenage boys. Loss of one testicle does not prevent a man from having children, however it can cause problems for the remaining testicle later in life.
Causes
The main cause of testicular torsion is the presence of an abnormality in the body's internal layout of tissue and organs that makes the testicle susceptible to twisting around the spermatic cord. Occasionally intense physical activity and / or trauma (ie injury to the testicle) can cause the condition.
Symptoms
The main symptom of testicular torsion is sudden and intense pain in the scrotum and sometimes in the abdomen as well. In some cases, this can cause vomiting and nausea. It generally occurs 'out of the blue' with no apparent external cause. Pain may be accompanied by swelling of the scrotum. Testicular torsion often occurs while asleep.
With boys under the age of 8 there may be no pain in the scrotum and only pain in the abdomen.
Tests / Diagnosis
Where the symptoms above are present, the most important consideration is urgent surgical assessment since, if testicular torsion is present, it must be surgically corrected very shortly after occurrence. While the symptoms may be caused by another condition (e.g. infection, or epididymo-orchitis), testicular torsion must be excluded first.
Diagnosis of the condition involves visual and physical examination. Diagnosis can be challenging and sometimes a definitive diagnosis is only possible during surgery.