Understanding Testicular Torsion: Symptoms, Causes, and Emergency Treatment
Doctor explains the urgent signs and treatment of testicular torsion. Learn about symptoms, causes, and the critical need for immediate medical attention to prevent severe damage or loss of the testicle.
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Topic Breakdown
If you've had a sudden pain in your testicles or one of them feels like it's twisted around, then you might have had something called a testicular torsion. This is considered to be a Urological emergency, and in this video, we're going to cover the following items, all of which are time-stamped and split into sections.
First of all, what is a testicular torsion? Well, testicular torsion occurs when a testicle rotates, twisting the spermatic cord that brings blood to the scrotum. This reduced blood flow causes sudden and often severe pain and swelling. It's most common between 12 and 18 years of age, but it can occur at any age, even before birth, and it can run in families. Now, it's so important that you're seen as quickly as possible if you have this because it requires emergency surgery. If it's treated quickly, the testicle can usually be saved, but when blood flow has been cut off for too long, a testicle might become so badly damaged that it has to be removed. This obviously has important implications in terms of fertility.
So, what are the symptoms of a testicular torsion? When someone has a torsion, they often mention they've experienced sudden severe pain in the scrotum, which is the loose bag of skin under your penis that contains the testicles. They may also have a swelling of the scrotum, pain in the tummy, feeling sick, and even potentially vomiting and potentially a fever. When the doctor examines the testicles, they might find that one of the testicles is positioned higher than normal or at an unusual angle. Young boys who've got testicular torsion typically wake up due to scrotal pain in the middle of the night or early in the morning.
If this has happened to you or a family member, then it is imperative that they seek Emergency Care straight away. Prompt treatment can prevent severe damage or loss of the testicle if torsion has occurred. Even if you've had a sudden testicle pain or the sensation the testicle is rotated and then gone back, that goes away without treatment, you still need to seek medical attention because sometimes the testicle can twist and then untwist on its own. Surgery is commonly needed to prevent this from happening again.
So now we know what a torsion is, some of the symptoms, and that it's classed as an emergency. Well, what are some of the potential causes? Testicular torsion occurs when the testicle rotates on the spermatic cord, as I've already mentioned, and that's the vessel that brings blood into the testicle from the abdomen. If the testicle rotates several times, then blood flow can be entirely blocked, causing the damage more quickly. It's not fully clear why testicular torsion occurs, but most people who do get it usually have an inherited trait that allows the testicle to rotate freely inside the scrotum. This inherited condition often affects both testicles, but not every male with the trait will have a testicular torsion. The torsion can also occur several hours after vigorous activity, after a minor injury to the testicle, or while sleeping. Cold temperature or rapid growth of the testicle during puberty may also play a role.
So, what happens when you go to see your doctor about this problem? Your doctor will ask you questions to verify whether your signs and symptoms have been caused by a testicular torsion or potentially something else. Doctors often diagnose testicular torsion with a physical exam of the scrotum, testicles, abdomen, and groin. They may also test your reflexes by lightly rubbing or pinching the inside of your thigh on the affected side. Normally, this causes the testicle to contract and move upwards, but this reflex might not occur if you've had a torsion.
Ultimately, if you have had a torsion, then you're going to need emergency surgery to save the testicle. For this operation, you'll be put asleep, a cut or incision is made in the scrotum, the testicle is then examined, untwisted, and the testicle observed for return of blood supply. To prevent the torsion happening again, the testicle is going to be fixed in place with stitches, and to prevent torsion on the opposite side, the other testicle will also be fixed in position. The cuts are then closed with stitches that dissolve, so they don't need to be removed later. If a twist is not found, the testicle will still be examined to look for other causes of your symptoms, such as infection. If the testicle hasn't survived, it will be removed.
Surgery, of course, comes with risks and benefits, and the British Association of Urological Surgeons has put together a great list of potential complications and information about surgery, and I've included a link to this in the description box. Some of these potential complications or risks include infection in the wound, collection of blood around the testicle, which is called a hematoma, unfortunately, loss of the testicle in the future, even though it was hoped the testicle had been saved, as well as long-term scrotal pain.
Finally, let's just go over some top tips for recovery after the operation. Here in the UK, the stitches that are used are dissolvable, so these don't need to be removed. You might have some discomfort for a few days, and in this case, you should take regular painkillers, so things like paracetamol for at least two days and for a few days longer if you need to. You should also wear supportive brief-style pants rather than loose-fitting boxers for two weeks, as these can increase comfort. You may have been given underwear called a scrotal support, which are medical-grade supportive pants, and these can be swapped to normal cotton pants if you prefer and they're more comfortable after a few days. You should make sure that you rest for a few days at home and take a week off school, college, or work. You should also avoid swimming for seven to ten days and avoid strenuous activities, for example, physical exercise or riding a bike for at least three to four weeks. The wound site should be kept clean and dry, and it's fine to take showers after two days, but you should avoid taking baths for five days. Finally, if you feel unwell, you've got a fever, you've noticed increased pain, or noticed discharge at the wound site, you need to let the medical team know as soon as possible because this could be the sign of an infection.
Finally, all boys and men, regardless of age, should regularly check their testicles every month to make sure that they can't feel any lumps or bumps. If you do notice any lumps, bumps, or your testicles don't feel the same as normal, make sure you speak to your doctor.
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