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Torsion testis: Treatment, symptoms, advice and help

About torsion testes

Torsion testes refer to the spermatic cord that provides the blood supply to the testes getting twisted, cutting off the blood supply, often causing pain. Prolonged testicular torsion will result in the death of the testicle.

Torsion of the testes: Incidence, age and sex

Clinical features testicular torsion is most common between 10 and 25 years of age although a few cases may occur in infancy.

Signs and symptoms of torsion: Diagnosis

Symptoms vary with the degree of torsion. Most commonly there is sudden agonizing pain in the groin and the lower abdomen. The patient feels nauseated and may vomit.

Torsion of a fully descended testes is usually easily recognised. The testis seems high and the tender twisted cord can be palpated above it. Elevation of the testis reduces the pain in epididymo-orchitis and makes it worse in torsion. Doppler ultrasound scan will confirm the absence of the blood supply to the affected testis.

Causes & prevention of torsion of the testes

For torsion to occur some abnormality in the attachment of the testes must be present.

Straining at stool, lifting a heavy weight and coitus are all possible precipitating factors. Alternatively, torsion may develop spontaneously during sleep.

Torsion of the testes: Complications

If symptoms have been present for more than 12 hours the testes may become gangrenous. An infracted testis should be removed – the patient can be counselled later about a prosthetic replacement. The affected testis will become woody-hard and atrophy to a fibrous nodule.

Torsion of the testes: Treatment

If there is any doubt about the diagnosis, the scrotum should be explored without delay.

In the first hour or so, it may be possible to untwist the testis by gentle manipulation. If manipulation is successful, pain subsides and the testis is out of danger. Arrangements should be made for early operative fixation to avoid recurrent torsion.

On exploration if the testis is viable when the cord is untwisted it should be prevented from twisting again by fixation with non-absorbable sutures between the tunica vaginalis and the tunica albuginea. The other testis should also be fixed because the anatomical predisposition is likely to be bilateral.