Testicular torsion refers to twisting of the testis on the spermatic cord which carries the blood vessels that supply blood to the testis and the scrotum. This twisting may partially or completely cut off blood supply to the affected testis and the scrotum, leading to the death of the affected testis if left for too long.

The sudden cut off of blood supply results in severe pain and swelling on the affected side. This pain may radiate to the abdomen. It is an emergency condition which requires an emergency response to salvage the affected testis.

What are the risk factors for testicular torsion? 

1. Age - Adolescent boys between age 12 and 18 are most susceptible to testicular torsion, though older or younger males can be affected. Testicular torsion has been reported before birth and in newborns.
2. Family history of testicular torsion - Boys who have affected family members are at risk of testicular torsion
3. Previous testicular torsion - Those who have had an episode of testicular torsion before in form of intermittent torsion can have a repeat episode. The more frequent this occurs, the more the likelihood of testicular damage 

Why does testicular torsion occur?

The reason why testicular torsion occurs is not clear. However, it has been shown to be hereditary as most males who have testicular torsion have freely mobile testes inside the scrotum. In those with the risk factors, testicular torsion occurs after rigorous activities or a minor injury to the testis.

It may however occur at rest, with no precipitating factor, even while sleeping. The rapid growth of the testes during puberty has also been implicated as a factor. 

How does testicular torsion occur?

Testicular torsion occurs due to rotation of the testis on the spermatic cord which carries the blood vessels supplying the testis. This turning results in occlusion of the blood vessels supplying the testis.

If this rotation occurs once or twice, it may take a longer time for the testis to undergo significant damage than if it rotates several times, as little blood flow to the testis may still occur in such a case.

Symptoms and signs of testicular torsion

These include: 

1. Sudden severe pain which is too difficult for the sufferer to bear. Affected patient may wake up from sleep with this pain.
2. Swelling of the scrotum, resulting from congestion due to obstruction to blood flow.
3. Lower abdominal pain.
4. Frequent urination.
5. Fever.
6. Nausea and vomiting.
7. Testis positioned higher than normal and than the normal one.

What investigations are necessary for diagnosis of testicular torsion?

The following investigations may help in the management of a patient with testicular torsion.

1. Urine test – This is used to rule out urinary tract infection as the cause of the pain being felt by the patient.
2. Scrotal ultrasound – This ultrasound is used to determine blood flow to the testis. Reduced blood flow to the testis may support the diagnosis. However, not confirming reduced blood flow does not necessarily rule out testicular torsion.

For a patient whose diagnosis is straightforward from signs and symptoms, and who may have taken some time before getting to the hospital, surgery may be carried out without waiting for further investigations as time is of the essence in salvaging the affected testis.

What is the treatment modality for testicular torsion?

The treatment for testicular torsion involves surgery. During the procedure, the testis is untwisted and examined for a while to know if it is still alive. If it turns pink, as evidence of blood flowing through it, it will then be fixed to the scrotal sac to prevent it from moving around and undergoing torsion again.

In cases where the testis has turned black and cannot regain its blood supply after untwisting it, it will need to be removed. The other testis may also need to be fixed, as it may later be affected, even though it is unaffected as at the time of treating the affected testis. 

It should be noted that time is of the essence in this instance. The sooner the testis is untwisted, the better the chances that the testis can be saved. The chance of having to remove the testis increases with the time taken before the surgery is done.

It has been noted that if surgery is not carried out within six hours of the commencement of scrotal pain, the chance of having to remove the testis is very high.

What are the complications of testicular torsion?

1. Damage to the testis – This may occur if testicular torsion is not treated on time due to lack of blood supply which denies the testis of oxygen and nutrients.
2. Loss of testis – Badly damaged testis may need to be removed since it cannot function in hormone production and fertility.
3. Infertility – Damaged / dead testis cannot produce spermatozoa. If this affects the two testes, male infertility will be the result.

What is the preventive measure against testicular torsion?  

Boys prone to having testicular torsion (those who have had intermittent torsion and those with freely mobile testes) should have their testes fixed to the wall of the scrotum by surgical procedure.