Torsion testis – How is it managed and who is at risk for it?

Testes are the reproductive organs in men. Torsion of the testis is a condition where the testis spins leading to twisting of the spermatic cord. As the spermatic cord undergoes twisting due to any cause, the blood vessel to the testis (testicular artery) would undergo occlusion, decreasing the blood supply of the testis leading to testicular damage and ultimately causes death if not treated immediately.

Testicular torsion usually occurs in two different age groups:

     Neonatal period (fortunately very rare)

     Peri-pubertal period (i.e. in adolescents aged 12 to 18 years)

Risk Factors of Testicular Torsion are:

  • If someone in your family has suffered from this condition, you could be susceptible to it. Presence of the bell-clapper deformity can also lead to testicular torsion.
  • If you receive minor trauma such as the one during playing any kind of contact sports, outdoor activities or even while doing house work, it can be a reason of this condition as well.
  • Heavy exercising or running in an unbalanced or improper manner can cause torsion as well.
  • Improper sleeping positions can also cause torsion and is a common cause behind frequent torsion and detorsion.
  • Previous history of testicular pain that became alright on its own (torsion and detorsion) may increase the chances of it happening again.
  • Other factors: Excessively cold temperatures wherein the scrotum contracts rapidly and prolonged contraction can cause torsion. Fast growth of the scrotum during the adolescent years after puberty may cause torsion.

Testicular Torsion Diagnosis:

1.Physical Examination

In most cases, diagnosis is made based on the patient’s or patient’s family history and physical findings. Testicular torsion is a surgical emergency, and delaying surgery might cause irreversible damage to the testis and infertility.

2.Scrotal Doppler Ultrasound Study

In certain cases, if the pain is of very recent onset, the surgeon may order a Doppler ultrasound to check the blood flow to the testis. In torsion, the blood supply will be reduced.

However, in most cases if the pain has been there for a prolonged duration of time, the patient is directly taken up for surgery without any further delay in a bid to salvage the testis.

Management of testicular torsion:

Manual Detorsion

Testicular torsion is a surgical emergency. In some cases, the torsion might be manually corrected during initial examination, before any diagnostic imaging.

Surgery for Torsion Testis

Immediate surgical treatment is the best option to salvage the testis when torsion occurs in children or young adults.

A good history, clinical experience of the doctor and a high index of suspicion are usually the factors on which a decision is taken for performing the surgery and in most instance the surgery is done under local or regional anesthesia within 2 to 4 hours if not earlier.  

The rate of salvage of the testis is high if the surgery is done within 4 to 6 hours and drops to almost zero at 12 hours. In this procedure the testes are fixed to the posterior wall and they are preserved functionally. Its called as orchidopexy.

If the testis looks gangrenous and does not get restored after the cord is untwisted, it is best advised to be removed. It’s called orchiectomy.

Complications of Testicular Torsion:

If untreated, torsion of the testis may lead to-

  • Damage to the testis due to lack of blood flow (infarction) and its atrophy
  • Decreased fertility or infertility – reduced or absent chances of fathering children

-Dr.Bhavani Sagar Surampally

 

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