Testicular Torsion

Definition | Aetiology | Pathophysiology | Risk Factors | Signs and Symptoms | Investigations | Management | Example Management | References

Definition

Testicular torsion is a urological emergency that occurs when the spermatic cord twists, cutting off the blood supply to the testicle. This condition requires immediate medical attention to prevent testicular loss.

Aetiology

Testicular torsion can occur due to various factors, including:

• Bell-Clapper deformity: A congenital anomaly where the testicle is inadequately attached to the scrotum, allowing it to move freely and potentially twist.
• Trauma: Direct injury to the testicle or scrotum.
• Sudden movements or physical activity: May trigger torsion in susceptible individuals.
• Cold temperatures: Sudden exposure to cold can cause the cremasteric reflex to contract and potentially twist the spermatic cord.

Pathophysiology

In testicular torsion, the twisting of the spermatic cord leads to venous occlusion and engorgement, followed by arterial ischaemia. This can result in infarction and necrosis of the testicular tissue if not promptly treated. The degree of torsion and duration of ischaemia determine the extent of testicular damage.

Risk Factors

• Age: Most common in males aged 12-18 years but can occur at any age.
• Congenital anomalies: Such as the bell-clapper deformity.
• Family history: Increased risk if there is a family history of testicular torsion.
• Previous torsion: Having experienced testicular torsion before increases the risk of recurrence.
• Cold weather: Sudden exposure to cold temperatures.

Signs and Symptoms

• Sudden, severe testicular pain, often unilateral.
• Scrotal swelling and redness.
• Nausea and vomiting.
• Abdominal pain: May also be present.
• Testicle positioned higher in the scrotum or at an unusual angle.
• Absent cremasteric reflex: Stroking the inner thigh does not cause the testicle to rise.

Investigations

• Clinical history and physical examination: Focus on scrotal and abdominal examination.
• Doppler ultrasound: To assess blood flow to the testicle and confirm diagnosis.
• Urinalysis: To rule out infection.
• Blood tests: Full blood count (FBC) and inflammatory markers if infection is suspected.

Management

Primary Care Management

• Immediate referral to the emergency department: Testicular torsion is a surgical emergency.
• Stabilise the patient: Ensure airway, breathing, and circulation (ABCs).
• Analgesia: Provide pain relief while awaiting transfer.

Specialist Management

• Urgent surgical intervention: Detorsion and fixation (orchidopexy) of the affected testicle to restore blood flow.
• Fixation of the contralateral testicle: To prevent future torsion.
• Post-operative care: Monitoring for complications and ensuring proper recovery.

Example Management for Testicular Torsion

A patient presenting with sudden, severe testicular pain and swelling should be urgently referred to the emergency department. Immediate management includes providing analgesia and stabilising the patient. Definitive treatment involves urgent surgical intervention to detorse and fix the affected testicle, and prophylactic fixation of the contralateral testicle to prevent future episodes. Regular follow-up is essential to monitor recovery and manage any complications.

References

1. NICE. (2024). Testicular Torsion: Diagnosis and Management. Retrieved from NICE
2. NHS. (2023). Testicular Torsion. Retrieved from NHS
3. British Association of Urological Surgeons (BAUS). (2022). Testicular Torsion. Retrieved from BAUS
4. Molokwu, C. N., & Hayes, M. C. (2010). Testicular Torsion: An Overview. Urology Annals.

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