The most common cause of a urologic emergency related to the 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. When a man experiences torsion of 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 (AUA), it’s uncommon and affects only about 1 in 4,000 young men. Torsion is most common in adolescent males. However, older men and infant boys can also be affected.
Most men who have testicular torsion are born with a higher risk for the condition although they may not know it. Normally, the testicles can’t move freely inside the scrotum. The surrounding tissue is strong and supportive. Men and boys who experience torsion sometimes have weaker connective tissue in the scrotum. This is called 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.
Testicular torsion can also occur after an injury to the groin. Rapid growth during puberty may also cause the condition.
The condition can occur anytime. Testicular torsion can occur when a man is sleeping or when he is engaging in physical activity. Sports injuries can cause torsion of the testes. As a preventive step, a man can wear a cup for contact sports.
Testicular torsion usually occurs in only one testicle. Bilateral torsion, when both testes are simultaneously affected, is extremely rare.
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. Some men also experience:
- lumps in the scrotal sac
- blood in the semen
There are other potential causes of severe testicular pain, such as epididymitis, but you should still take these symptoms seriously and seek emergency treatment.
Tests can be used to diagnose torsion. These include:
- physical exam
- urine tests, which look for infection
- 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 it’s lower than normal, you may be suffering from torsion.
Torsion of the testes is a medical emergency, but many adolescent males are hesitant to say they’re hurting or seek treatment right away. You should never ignore sharp testicular pain.
It’s possible for some men to experience what’s known as intermittent torsion. This causes a man to have a testicle 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 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 will 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.
According to the Mayo Clinic, 95 percent of men treated for testicular torsion within six hours of the onset of pain don’t ultimately require testicle removal. However, an estimated 90 percent of men do require surgical removal of the testicle if treatment is delivered 48 hours or more after the pain starts.
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 motility (sperm’s ability to move).
You should seek emergency medical attention right away if you suspect that you or your child are experiencing testicular torsion to avoid these possible complications. Testicular torsion surgery is highly effective if the condition is caught early.