Testicular torsion must be regarded as an emergent situation in urology. It occurs most often in boys under the age of 18, but it may rarely affect even the older men. The testis is paired organ where the male gametes (sperm) and male sex hormones are produced. The testicles are located in the scrotum and the blood supply is ensured by local blood vessels coming from the abdominal cavity.
The torsion usually happens when the affected testicle rotates around its axis to the extent that the rotation strangulates the blood vessels and disrupts the blood flow into the testicle. It is a similar problem as the ovarian torsion in women.
Schema -Testicular torsion with a constriction of its blood vessels
The torsion usually occurs at rest without any clear causes and manifests with a sudden and shocking pain in the affected testicle, which may irradiate into the groin and lower abdomen. The condition is frequently accompanied with nausea and vomiting. Similar symptoms are present for example in epididymitis.
In case of a sharp pain in the testicle, it is advisable to visit a doctor, in ideal case a urologist. The patient must be physically examined and an ultrasound may confirm the absence of blood flow into the testicular tissue. When there is reasonable suspicion of torsion, the urologists must perform surgery, which is both diagnostic and therapeutic.
The testicle can be derotated and put into correct position manually. However, this is quite a painful procedure and not entirely reliable. Therefore, the main therapeutic option is a urological operation where the doctors open the scrotal sac, derotate the testicle and fix it by few stitches to the inner wall of the scrotum to prevent repeating of the torsion. The time is the main factor. When the operation is not performed within 6 hours after the onset of the symptoms, the testicular tissue dies and the testicle must be removed.