TESTICULAR TORSION

Testicular torsion refers to the abnormal twisting of the testicle and the spermatic cord. One important function of the testes is the production of sperm. The sperm travel from the testes to tiny tubes called efferent ductules. These tiny ductules attach to the epididymis. The epididymis is a long folding tube that if stretched out measures nearly 20 feet in length. The epididymis then attaches to the tube called the vas deferens (this is the structure that is cut when undergoing a vasectomy). The vas deferens, the main artery and veins that feed and drain the testes, and the connecting tissue covering these structures all form the spermatic cord. When the testicle and spermatic cord twists on itself like a corkscrew, this results in a cutoff of vital blood supply to the testicle and is known as testicular torsion.

Testicular torsion occurs most often in young men between the ages of 12 and 20 years. Torsion is rare, occurring in 1 in 5000 males. The specific cause is unknown. It can occur suddenly and be unprovoked. Torsion is not contagious and is not transmitted from one person to another. Torsion of the testicle is considered an emergency and, if treated promptly, can be cured.

Testicular torsion usually presents with sudden onset of severe pain in the testicle. The testicle can be swollen, tender to touch, and retracted or drawn up towards the abdomen. Sometimes lower abdominal pain with nausea is associated with the testicular pain. Torsion can sometimes be confused with epididymitis (infection of the epididymis) or orchitis (infection of the testicle). Sometimes the only way to tell the difference between torsion and the other possible causes of pain is to perform a scan of the testes using the nuclear material called technetium-99. If testicular torsion is present, the scan shows low blood flow to the testicle. This warrants immediate surgical consultation.

Immediate surgical treatment to prevent permanent damage to the testicle or loss of the testicle is indicated if torsion is present. Surgery untwists the testicle and the spermatic cord and places the structures in their normal positions. All attempts are made to save the testicle; however, if the blood supply has been cut off for a long period of time, this will lead to gangrene of the testicle and therefore warrant its complete removal.

Sometimes it is difficult to diagnose torsion by the nuclear scan. If the clinical suspicion is high, your doctor may recommend surgical exploration to rule out torsion. This needs to be decided on a case-by-case basis between you and your doctor.

• Remember that torsion is a surgical emergency. If you experience any of the symptoms mentioned above, don't wait; make sure you are seen by your doctor or the local emergency room.
• Remember that the urologist (surgeon who specializes in diseases of the genital and urinary tract) is the person best trained for this procedure.
• Perform testicular examinations. Although this disease is usually sudden in onset, sometimes it can be gradual; if you detect swelling, fullness, or any lumps, make sure you report this to your physician.
• Remember that torsion can sometimes lead to infertility.

• Don't ignore a painful testicle.
• Don't be afraid to ask for a urologist's opinion.
• Don't miss follow-up appointments with the urologist after surgery is done.
• Don't be misled. The loss of one testicle does not mean loss of erections, loss of orgasms, or loss of the ability to have children.

• If you have any pain in the testes.
• If you have any testicular swelling.
• If you feel a lump on your testicle.
• If you have any fever, bleeding, or pain after surgery for torsion.
• If you need a referral to a urologist.
• If you are concerned about infertility.

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