The most common cause of an emergency related to the male genitourinary tract is a highly painful one called testicular torsion.
Men have two testicles that rest inside the scrotum. A cord known as the spermatic cord carries blood to the testicles. During a torsion of the testes, this cord twists. As a result, blood flow is affected and the tissues in the testicle can start to die.
According to the American Urological Association, this condition is uncommon and affects only about 1 in 4,000 under the age of 25.
Torsion is most common in adolescent males. Those between 12 and 18 years old account for 65 percent of people with the condition, according to Cleveland Clinic. However, infants and older adults can also be affected.
Many of those who have testicular torsion are born with a higher risk for the condition, although they may not know it.
Congenital factors
Normally, the testicles can’t move freely inside the scrotum. The surrounding tissue is strong and supportive. Those who experience torsion sometimes have weaker connective tissue in the scrotum.
In some instances, this may be caused by a congenital trait known as a “bell clapper” deformity. If you have a bell clapper deformity, your testicles can move more freely in the scrotum. This movement increases the risk of the spermatic cord becoming twisted. This deformity accounts for 90 percent of testicular torsion cases.
Testicular torsion can run in families, affecting multiple generations as well as siblings. The factors contributing to a higher risk aren’t known, though a bell clapper deformity may contribute. Knowing that others in your family have experienced testicular torsion can help you request emergency treatment immediately if its symptoms affect you or someone in your family.
Not everyone who experiences this condition has a genetic predisposition to it, however. Approximately 10 percent of those with testicular torsion have a family history of the condition, according to one small study.
Other causes
The condition can occur at any time, even before birth. Testicular torsion can occur when you’re sleeping or engaging in physical activity.
It can also occur after an injury to the groin, such as a sports injury. As a preventive step, you can wear a cup for contact sports.
Rapid growth of the testicles during puberty may also cause the condition.
Pain and swelling of the scrotal sac are the main symptoms of testicular torsion.
The onset of pain may be quite sudden, and the pain can be severe. Swelling may be limited to just one side, or it can occur in the entire scrotum. You may notice that one testicle is higher than the other.
You may also experience:
- dizziness
- nausea
- vomiting
- lumps in the scrotal sac
- blood in the semen
There are other potential causes of severe testicular pain, such as the inflammatory condition epididymitis. You should still take these symptoms seriously and seek emergency treatment.
Testicular torsion usually occurs in only one testicle. Bilateral torsion, when both testes are simultaneously affected, is extremely rare.
Tests that can be used to diagnose torsion include:
- urine tests, which look for infection
- physical exams
- imaging of the scrotum
During a physical exam, your doctor will check your scrotum for swelling. They may also pinch the inside of your thigh. Normally this causes the testicles to contract. However, this reflex may disappear if you have torsion.
You might also receive an ultrasound of your scrotum. This shows blood flow to the testicles. If blood flow is lower than normal, you may be experiencing torsion.
Torsion of the testes is a medical emergency, but many adolescents are hesitant to say that they’re hurting or seek treatment right away. You should never ignore sharp testicular pain.
It’s possible for some to experience what’s known as intermittent torsion. This causes a testicle to twist and untwist. Because the condition is likely to recur, it’s important to seek treatment, even if the pain becomes sharp and then subsides.
Surgical repair
Surgical repair, or orchiopexy, is usually required to treat testicular torsion. In rare cases, your doctor may be able to untwist the spermatic cord by hand. This procedure is called “manual detorsion.”
Surgery is performed as quickly as possible to restore blood flow to the testicles. If blood flow is cut off for more than six hours, testicular tissue can die. The affected testicle would then need to be removed.
Surgical detorsion is performed under general anesthesia. You’ll be asleep and unaware of the procedure.
Your doctor will make a small incision in your scrotum and untwist the cord. Tiny sutures will be used to keep the testicle in place in the scrotum. This prevents rotation from occurring again. The surgeon then closes the incision with stitches.
Orchiopexy doesn’t typically require an overnight stay in the hospital. You’ll stay in a recovery room for several hours prior to discharge.
As with any surgical procedure, you may have discomfort after surgery. Your doctor will recommend or prescribe the most appropriate pain medication. If your testicle needs to be removed, you’ll most likely stay in the hospital overnight.
Pain relief
Your doctor will most likely use dissolvable stitches for your procedure, so you won’t need to have them removed. After surgery, you can expect your scrotum to be swollen for two to four weeks.
You can use an ice pack several times a day for 10 to 20 minutes. This’ll help to reduce swelling.
Hygiene
The incision made during surgery may also ooze fluid for one to two days. Make sure to keep the area clean by washing gently with warm, soapy water.
Rest and recovery
Your doctor will recommend refraining from certain types of activities for several weeks following surgery. These include sexual activity and stimulation, such as masturbation and intercourse.
You’ll also be advised to avoid athletic or strenuous activities. During this time, it’s also important to refrain from heavy lifting or straining during bowel movements.
Make sure to get plenty of rest to allow your body to fully recover. Don’t remain completely sedentary, however. Walking a little bit each day will help increase blood flow to the area, supporting recovery.
Testicular torsion is an emergency requiring immediate care. When not treated quickly, or at all, this condition can result in severe complications.
Infection
If a dead or severely damaged testicle tissue isn’t removed, gangrene may occur. Gangrene is a potentially life-threatening infection. It can spread rapidly throughout your body, leading to shock.
Infertility
If damage occurs to both testicles, infertility will result. If you experience the loss of one testicle, however, your fertility shouldn’t be affected.
Cosmetic deformity
The loss of one testicle can create a cosmetic deformity which may cause emotional upset. This can, however, be addressed with the insertion of a testicular prosthesis.
Atrophy
Untreated testicular torsion can result in testicular atrophy, causing the testicle to shrink significantly in size. An atrophied testicle can become unable to produce sperm.
Testicular death
If left untreated for more than several hours, the testicle may become severely damaged, requiring its removal. The testicle can usually be saved if it’s treated within a four-to-six-hour window.
After a period of 12 hours, there’s a 50 percent chance of saving the testicle. After 24 hours, the chances of saving the testicle drop to 10 percent.
Other conditions affecting the testicles may cause symptoms similar to those of testicular torsion.
No matter which of those conditions you think you may have, it’s important to see your doctor immediately. They can rule out testicular torsion or help you obtain any necessary treatment.
Epididymitis
This condition is typically caused by a bacterial infection, including sexually transmitted infections such as chlamydia and gonorrhea.
Symptoms of epididymitis tend to come on gradually and may include:
- testicular pain
- painful urination
- redness
- swelling
Orchitis
Orchitis causes inflammation and pain in one or both testicles as well as the groin.
It can be caused by either a bacterial or a viral infection. It’s often associated with the mumps.
According to TeensHealth, 90 percent of people treated for testicular torsion within four to six hours of the onset of pain don’t ultimately require testicle removal.
However, if treatment is delivered 24 hours or more after the pain starts, an estimated 90 percent do require surgical removal of the testicle.
Removal of a testicle, called orchiectomy, can affect hormone production in infants. It may also affect future fertility by lowering sperm count.
If your body begins to make anti-sperm antibodies because of torsion, this can also lower sperm’s ability to move.
To avoid these possible complications, you should seek emergency medical attention right away if you suspect that you or your child are experiencing testicular torsion. Testicular torsion surgery is highly effective if the condition is caught early.
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