Microscopic pathology image showing a section of testis with hemorrhage and ischemic necrosis due to testicular torsion (Torsion of testis).
What are the other Names for this Condition? (Also known as/Synonyms)
- Testicular Ischemia
- Torsion of the Testis
- Winter Syndrome
What is Testicular Torsion? (Definition/Background Information)
- Testicular Torsion is a medical emergency in which the testicle rotate and cause the spermatic cord (the cord which supplies blood to the scrotum) to bend and twist, leading to a condition termed as ischemia. ‘Ischemia’ means the cutting-off of the blood supply, in this case, to the testicles
- Testes are male sex glands which are located behind the penis within a sac-like pouch called the scrotum. Testicular Torsion affects young males (mostly adolescents), those who are below 25 years of age
- The most common cause of this condition is “Bell-Clapper deformity”, a congenital malformation in which the testes are not securely fixed to the scrotum and are free to move on its own
- Torsion of the Testis causes severe pain and swelling of the testicles and needs an urgent surgery to save the testicles. An emergency ultrasound will help in evaluation of the condition
- With early and efficient treatment, Testicular Torsion has good prognosis. However, in case the testicular blood flow is cut-off for a long period, it may cause permanent damage to the testicles requiring their removal
Some of the variants of Testicular Torsion include:
- Intermittent Testicular Torsion
- Extravaganza Testicular Torsion
- Torsion of the Testicular Appendix
Who gets Testicular Torsion? (Age and Sex Distribution)
- Testicular Torsion can occur in males of any age, including at infancy stage or even before birth. But, it is most commonly found in adolescent males, between the age group of 12 to 16 years
- No racial, ethnic, or geographical location predominance is observed
- The condition affects 1 in 4000 males, who are younger than 25 years of age
What are the Risk Factors for Testicular Torsion? (Predisposing Factors)
Following are the risk factors that can increase the incidence of Testicular Torsion:
- Age: Males in the 12-16 years age group have a high risk
- Previous history of Testicular Torsion
- Family history: If there are other family members who have also been affected by this disorder
- Bell-Clapper deformity: It is a congenital birth defect in which the testicles are not properly attached to the scrotum; they are free to rotate and move on their own
- Temperature: Testicular Torsion is also called Winter Syndrome, because it occurs more frequently in cold conditions
It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.
Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.
What are the Causes of Testicular Torsion? (Etiology)
- Testicular Torsion is a medical condition that occurs due to a rotation of the testicles, causing the spermatic cord to twist itself, thereby preventing blood flow to the scrotum
- The testicular defect may occur sometimes due to Bell Clapper deformity, a congenital defect, in which the testis is not properly attached to the scrotum. This causes the testicles to move around freely inside the scrotum. Bell Clapper deformity usually causes bilateral Testicular Torsion, meaning that both the testicles are affected
Other possible causes of Testicular Torsion include:
- Physical activity such as riding a motorbike and vigorous exercise
- Injury to the scrotum
- Cold temperatures
- Rapid and unusual growth of the testicles during puberty
What are the Signs and Symptoms of Testicular Torsion?
The common signs and symptoms associated with Testicular Torsion include:
- Severe pain in the scrotum/testis
- Swelling of the scrotum
- Tenderness of the testicles
- A lump, which can be seen in the testicles
- Presence of blood in the semen
- Decreased or absent cremasteric reflex: It is a reflex that is activated by striking the middle or upper part of the thigh, which makes the cremaster muscle to contract and pull up the testicles on the side that is stroked
- Pain in the abdomen
- Nausea, vomiting
- Unusual and abnormal positioning of the testicle
- Rarely, low-grade fever may also be present
How is Testicular Torsion Diagnosed?
The diagnosis of Testicular Torsion may include:
- A complete medical history along with a thorough physical exam, with special emphasis on genital examination. During the physical exam, the physician will look for:
- Swelling of the testes
- Tenderness of the testes
- Decreased/absent cremasteric reflex
The diagnostic tests for Testicular Torsion may include:
- Scrotal ultrasound: It is the best and most efficient imaging tool to diagnose a Testicular Torsion
- Radionuclide scanning of the scrotum is also a more accurate tool
- Urine analysis: To check for the presence of any infection
Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.
What are the possible Complications of Testicular Torsion?
Testicular Torsion may lead to the following complications:
- Permanent damage or death of the testicles, when treatment is delayed, if the condition is not promptly diagnosed, or if there is no treatment provided
- Infertility: The loss of testicles will affect the ability to procreate
How is Testicular Torsion Treated?
Surgery is the most effective way to correct Testicular Torsion. The sooner the surgery is performed, the greater is the chance of saving the testicles.
- When the surgery is done within 6 hours, the success rate is about 95%
- When the surgery is delayed for more than 6 hours, the success rate for saving the testicle gets reduced to 20%
- The treatment for Testicular Torsion in newborns and infants is a non-emergency surgical procedure
- When blood flow to the testicles is cut off for a long duration of time, it causes permanent testicular damage that may require their removal. Orchiectomy is the surgical procedure to remove the testes
How can Testicular Torsion be Prevented?
- Testicular Torsion occurs because the testicles are not properly attached to the scrotum and free to rotate on their axis. The condition may be prevented in ‘at risk’ individuals by performing a surgery, to attach both testicles firmly to the inside of the scrotum
- All boys must be educated that even a small pain in the scrotum or testicles needs immediate medical attention by a physician, because any inadvertent delay may result in a permanent damage to the testes
What is the Prognosis of Testicular Torsion? (Outcomes/Resolutions)
- With Testicular Torsion, an early diagnosis and emergency surgery can save the testicles
- The longer the treatment is delayed, the greater is the risk of permanent testicular damage
- With early and efficient treatment, Testicular Torsion has good prognosis
Additional and Relevant Useful Information for Testicular Torsion:
The following DoveMed website link is a useful resource for additional information:
What are some Useful Resources for Additional Information?
Urology Care Foundation
1000 Corporate Boulevard, Linthicum, MD 21090
Phone: (410) 689–3700
Toll-Free: 1 (800) 828–7866
Fax: (410) 689–3998
References and Information Sources used for the Article:
http://kidshealth.org/parent/medical/kidney/torsion.html# (accessed on 4/30/2015)
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001545/ (accessed on 4/30/2015)
http://www.nlm.nih.gov/medlineplus/ency/article/000517.htm (accessed on 4/30/2015)
http://www.urologyhealth.org/urology/index.cfm?article=34 (accessed on 4/30/2015)
http://www.aafp.org/afp/2006/1115/p1739.html (accessed on 4/30/2015)
Helpful Peer-Reviewed Medical Articles:
Cox, A. M., Patel, H., & Gelister, J. (2012). Testicular torsion. Br J Hosp Med (Lond), 73(3), C34-36.
Cubillos, J., Palmer, J. S., Friedman, S. C., Freyle, J., Lowe, F. C., & Palmer, L. S. (2011). Familial testicular torsion. J Urol, 185(6 Suppl), 2469-2472. doi: 10.1016/j.juro.2011.01.022
Nandi, B., & Murphy, F. L. (2011). Neonatal testicular torsion: a systematic literature review. Pediatr Surg Int, 27(10), 1037-1040. doi: 10.1007/s00383-011-2945-x
Roth, C. C., Mingin, G. C., & Ortenberg, J. (2011). Salvage of bilateral asynchronous perinatal testicular torsion. J Urol, 185(6 Suppl), 2464-2468. doi: 10.1016/j.juro.2011.01.013
Yang, S. Y., & Xu, H. (2010). [Testicular torsion with atypical symptoms: seven cases report and review of the literature]. Zhonghua Nan Ke Xue, 16(8), 732-734.
Ringdahl, E., & Teague, L. (2006). Testicular torsion. American family physician, 74(10).
Cummings, J. M., Boullier, J. A., Sekhon, D., & Bose, K. (2002). Adult testicular torsion. The Journal of urology, 167(5), 2109-2110.
Dunne, P. J., & O’Loughlin, B. S. (2000). Testicular torsion: time is the enemy. Australian and New Zealand Journal of Surgery, 70(6), 441-442.