Testicular torsion is the stuff of literal nightmares for many men, and the reality is not much kinder than it sounds! The frightening thing about testicular torsion is that it can occur unprompted. That is to say that you can go to sleep one night and wake up in the morning with torsion. Testicular torsion is extremely painful and frightening and should be considered a medical emergency. But why is a twisted testicle an emergency? Let’s explore this further.
Why is Testicular Torsion a Medical Emergency?
What is testicular torsion?
Testicular torsion is when the tissue that surrounds the testicles is not well attached. This then gives the testes too much freedom of movement, and in turn, allows them to twist around the spermatic cord.
In effect, the testes have become “knotted” and the result is painful swelling and redness. This pain and swelling are caused by a build-up of blood which is meanwhile unable to pass through and get to the testicle.
A Little More Detail
The testicles, which are also referred to as testes, will normally hang in a pouch of skin called the scrotum. This is located just beneath the penis and is the point at which sperm and testosterone are produced.
Normally, blood is supplied to the two testes by the spermatic cord. This begins in the abdomen and travels down into the scrotum. This also contains something called “vas deferens” which essentially brings sperm to the urethra from the testicles.
Torsion occurs when tissue begins to choke this cord, which in turn stems from the flow of blood to the penis. This is normally observed in older men and only occurs in 1 in 4,000 males under the age of 25. Sadly though, testicular torsion can occur at any age, including in infants.
The reason this occurs in some men is that the testes might be born with a lack of tissue holding the testes to the scrotum. This gives the testes the ability to “swing” inside the scrotum. This is – somewhat graphically – described as a “bell clapper” deformity. Torsion will then normally occur on just one side.
Testicular Torsion Symptoms
The most obvious symptom of testicular torsion is sudden and very severe testicular pain on one side of the scrotum. Painful though this is, it is a very good thing, as it ensures that you can diagnose testicular torsion early.
In most cases, the two testes are of equal size. In cases of torsion, however, one testicle will often look much larger than the other.
Patients with testicular torsion may also be able to observe a change in color in the skin around the area – it will get redder or it will change color.
As soon as you notice this symptom you should be seen by a medical professional. You may not notice swelling right away, but as the issue is allowed to continue, you will usually notice severe swelling.
Many men also report that they feel nauseous and even begin to vomit spontaneously when they experience this urologic emergency.
Pain during urination is not a symptom of testicular torsion and may point to other issues. However, given the extremely serious nature of testicular torsion, it is worth checking to be sure. If there is another cause, then a physician can steer you in the right direction and advise the best course of treatment.
Why is Testicular Torsion a Medical Emergency?
It is extremely important that any men who notice testicular torsion symptoms get into surgery as quickly as possible. If you notice symptoms, call an ambulance and describe your symptoms.
The reason this is so important is that the reduced blood flow to the testicle can actually cause significant and possibly permanent damage. Blood and oxygen are needed in all parts of the body to fuel cells, and without those supplies, your cells will quickly die.
In the case of testicular torsion, you will often find that the testicles begin to shrink and may even “die, resulting in the loss of the testicle.
This shrinkage can occur in as little as six hours if blood isn’t restored to the area.
When a testicle dies, it will lead to severe discomfort in the testes, and many men report being unable to “get comfortable.”
In one study, it was found that ¾ patients needed to have the testicle surgically removed where surgery was delayed for more than 12 hours. Sadly, testes can rarely be saved in the case of newborn torsion.
For these reasons, you should seek medical attention from an emergency department as soon as you notice any of the symptoms described in this article.
If at all possible, you should aim to see a urologist. They will need to untwist (called de-torsion) the area in order to restore blood supply to the area. Every patient with torsion will need surgery and there is no way to untwist the testicle in the emergency room. It is also not possible to do it yourself, so don’t try!
In some cases, with successful detorsion, you may also receive some permanent stitches which will help to prevent torsion from occurring again. This often is done through the scrotum, but may also be done through the groin.
In cases where the testicle needs to be removed, the surgeon will always stitch the other testicle in order to keep it in place and prevent the issue from occurring on both sides. This can only occur at this point.
It can take a while to recover from testicular detorsion surgery. You may be required to take pain medication for a few days and within a few weeks, you should be able to return to your usual activities such as work and school. Also, patients should avoid any strenuous activity for several weeks.
You shouldn’t notice any difference if there are stitches in place.
In some cases, if one testicle is removed, you might find that the remaining testicle grows larger. This is called “compensatory hypertrophy.” Fortunately, only one working testicle is necessary for normal fertility and for male features.
A single testicle is capable of making the same amount of testosterone and sperm. However, up to one-third of patients may experience a lower sperm count following testicular torsion.
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