TESTICULAR TORSION Why ? What are the reasons? What are the symptoms?

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Testicular torsion is a serious medical condition where the spermatic cord, which provides blood flow to the testicle, becomes twisted. This twisting can cut off blood supply to the testicle, causing intense pain and potentially leading to testicular damage or loss if not treated promptly. Here's a breakdown of the key points:

Why Does Testicular Torsion Happen?

Testicular torsion occurs when the testicle rotates within the scrotum, causing the spermatic cord to twist. The spermatic cord contains blood vessels, nerves, and the vas deferens (the tube that carries sperm). When this cord twists, it cuts off blood flow to the testicle, which can lead to tissue damage.

Several factors or circumstances can increase the risk of testicular torsion:

1. Anatomical Factors: Some males are born with a condition called "bell clapper deformity," where the testicle is not properly attached to the scrotum, allowing it to rotate freely and increase the likelihood of twisting.

2. Trauma or Injury: A blow or injury to the groin can cause the testicle to twist, especially if there is pre-existing mobility of the testicle.

3. Rapid Growth: Testicular torsion is more common during periods of rapid growth, especially in males aged 12-18. This could be due to hormonal changes or increased physical activity during adolescence.

4. Cold Temperatures: Exposure to cold can cause the scrotal muscles to contract, which may trigger torsion in some individuals.

5. Exercise or Physical Activity: Sometimes torsion occurs after intense physical activity or sports, though this is less common than other causes.

6. Family History: In rare cases, there may be a genetic predisposition to testicular torsion.

Symptoms of Testicular Torsion

Testicular torsion presents with a sudden, severe pain in the scrotum. Other symptoms include:

• Severe, one-sided testicular pain: The pain often starts suddenly and may be sharp or stabbing.
• Swelling of the scrotum: The affected side of the scrotum may become visibly swollen or tender to touch.
• Redness of the scrotum: The skin of the scrotum may appear reddish or darker than normal.
• Nausea and vomiting: Due to the intense pain, nausea and vomiting are common.
• Abdominal pain: Pain may radiate to the lower abdomen, especially on the side of the affected testicle.
• High position of the testicle: The affected testicle may appear higher in the scrotum than normal, and sometimes the testicle may be at an abnormal angle.
• Absence of the cremasteric reflex: The cremasteric reflex is a reflex contraction of the cremaster muscle that raises the testicle when the inner thigh is stroked. In torsion, this reflex is usually absent on the affected side.

Diagnosis and Treatment

If testicular torsion is suspected, it is considered a medical emergency that requires immediate attention. Prompt treatment is critical to save the testicle and prevent permanent damage. Diagnosis may be made through:

• Physical examination: A doctor will typically check for tenderness, swelling, and changes in the position of the testicle.
• Ultrasound: This imaging test can help confirm the diagnosis by assessing blood flow to the testicle.
• Urine tests: Although not specific for torsion, these tests can help rule out other conditions like infection.

Treatment usually involves surgical intervention. The testicle may be untwisted manually (if caught early) or surgically, followed by fixation (orchidopexy) of the testicle to prevent further torsion. If blood flow has been cut off for too long (typically more than 6 hours), the testicle may not be salvageable, and it may need to be removed.

Complications

• Testicular atrophy: If blood flow is not restored quickly, the testicle may become permanently damaged and shrink (atrophy).
• Infertility: In rare cases, if the testicle is lost or damaged, it may impact fertility.
• Infection: Surgery carries a risk of infection, though this is rare.

When to Seek Medical Help

Anyone who experiences sudden, severe testicular pain, swelling, or discomfort should seek immediate medical attention, ideally within 6 hours of symptom onset. Quick treatment increases the chances of saving the testicle and avoiding complications.

Preventive Measures

While it's not always possible to prevent testicular torsion, those with a history of it or known anatomical issues may opt for preventive surgery (orchidopexy) to secure both testicles to the scrotum and reduce the risk of torsion.

In summary, testicular torsion is a medical emergency that requires quick diagnosis and treatment to avoid long-term damage. If you or someone you know experiences sudden testicular pain, don't delay seeking medical help.