Table of Contents
Overview – Testicular Torsion
Testicular torsion is a urological emergency characterised by twisting of the spermatic cord, leading to ischaemia of the testicle. It most commonly affects neonates and teenagers, and presents with sudden-onset unilateral testicular pain. Prompt diagnosis and surgical intervention within 6 hours is crucial to prevent irreversible testicular damage or loss.
Definition
Testicular torsion is the twisting of the spermatic cord, which compromises vascular supply and leads to testicular ischaemia and necrosis if untreated.
Aetiology
- Congenital:
- “Bell Clapper Deformity” – Free-floating testis lacking normal posterior fixation
- Precipitating Factors:
- Sudden cremasteric contraction (e.g. during exertion, trauma, or even at rest)
Pathogenesis
- Twisting of the spermatic cord →
- Venous outflow obstruction →
- Testicular congestion →
- Ischaemia and infarction
- Leads to haemorrhagic necrosis and potential gangrenous infection if untreated
Morphology
- Macroscopic:
- Swollen, dark, blackish discoloured testis
- Microscopic:
- Haemorrhagic necrosis of testicular tissue
Clinical Features
- Typical Age Groups:
- Neonates
- Teenagers (puberty-related hormonal and anatomical changes)
- Symptoms and Signs:
- Sudden, severe unilateral testicular pain
- Swollen, tender, elevated, and firm testis
- Pain may be relieved by passive elevation of the testis
- Absence of cremasteric reflex
- Nausea and vomiting often accompany pain
Diagnosis
- Doppler Ultrasound:
- Absent or reduced blood flow to affected testicle
- Clinical Signs:
- Absent cremasteric reflex
- Positive Prehn’s sign (pain relief upon elevation – sometimes unreliable)
Complications
- Testicular infarction
- Loss of testicle
- Infection or sepsis from gangrenous tissue
- Subsequent infertility (especially if bilateral torsion occurs)
Management
- Surgical Emergency – Within 6 hours for optimal salvage
- Manual detorsion may be attempted but surgery is definitive
- Orchidopexy of both testes (to prevent recurrence)
- Orchidectomy if the testicle is non-viable
- Analgesia and supportive care as interim management
Summary – Testicular Torsion
Testicular torsion is a surgical emergency characterised by acute scrotal pain caused by spermatic cord twisting, leading to ischaemia. Prompt recognition and intervention within 6 hours is vital to salvage the testicle. For more on related topics, visit our Reproductive Health Overview page.