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    Testicular torsion

    Torsion of the testis; Testicular ischemia; Testicular twisting

    Testicular torsion is the twisting of the spermatic cord, which supports the testes in the scrotum. When this occurs, blood supply is cut off to the testicles and nearby tissue in the scrotum.

    Causes

    Some men are more prone to this condition because of defects in the connective tissue within the scrotum. The problem may also occur after an injury to the scrotum that results in a lot of swelling or following heavy exercise. In some cases, there is no clear cause.

    The condition is more common during the first year of life and at the beginning of adolescence (puberty). However, it may happen in older men.

    Symptoms

    • Sudden severe pain in one testicle. The pain may occur without a clear reason.
    • Swelling within one side of the scrotum (scrotal swelling)
    • Nausea or vomiting
    • Lightheadedness

    Additional symptoms that may be associated with this disease:

    • Testicle lump
    • Blood in the semen

    Exams and Tests

    The health care provider will examine you. The exam may show:

    • Extreme tenderness and swelling in the testicle area
    • The testicle on the affected side is higher

    You may have a Doppler ultrasound of the testicle to check the blood flow. There will be no blood flowing through the area if you have complete torsion. Blood flow may be reduced if the cord is partially twisted.

    Treatment

    Most of the time, surgery is needed to correct the problem. Surgery should be done as soon as possible after symptoms begin. If it is performed within 6 hours, most testicles can be saved.

    During surgery, the testicle on the other side is often secured into place as well. This is because the unaffected testicle is at risk of testicular torsion in the future.

    Outlook (Prognosis)

    The testicle may continue to function properly if the condition is found early and treated right away. The chances that the testicle will need to be removed increase if blood flow is reduced for more than 6 hours. However, the testicle may lose its ability to function if torsion has lasted fewer than 6 hours.

    Possible Complications

    The testicle may shrink if blood supply is cut off for an extended time. It may need to be surgically removed. Shrinkage of the testicle may occur days to months after the torsion has been corrected. Severe infection of the testicle and scrotum is also possible if the blood flow is restricted for an extended period.

    When to Contact a Medical Professional

    Get emergency medical attention if you have symptoms of testicular torsion.

    Prevention

    Take steps to avoid injury to the scrotum. Many cases cannot be prevented.

    References

    Elder JS. Disorders and anomalies of the scrotal contents. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 539.

    Ban KM, Easter JS. Selected urologic problems In: Marx JA, Hockberger RS, Walls RM, et al, eds. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 8th ed. Philadelphia, Pa: Mosby Elsevier; 2013:chap 99.

    Wampler SM, Llanes M. Common scrotal and testicular problems. Prim Care. 2010;37:613-626.

    Barthold JS. Abnormalities of the testes and scrotum and their surgical management.In: Wein AJ, ed. Campbell-Walsh Urology. 10th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 132.

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      A Closer Look

        Tests for Testicular torsion

        Review Date: 10/2/2013

        Reviewed By: Scott Miller, MD, Urologist in private practice in Atlanta, Georgia. Also reviewed by David Zieve, MD, MHA, Bethanne Black, and the A.D.A.M. Editorial team.

        The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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