What causes testicular torsion

What is Testicular Torsion?

Testicular torsion is a medical emergency that happens when one of the testicles twists around the spermatic cord. The spermatic cord is a structure that runs from the abdomen to each testicle and contains the vas deferens, blood vessels, and nerves. When the testicle twists, it cuts off the blood supply to the testicle. This can cause severe pain and swelling, and if not treated promptly, can lead to the loss of the testicle.

What Causes Testicular Torsion?

The primary cause of testicular torsion is an anatomical abnormality known as the 'bell clapper' deformity. In most males, the testicles are secured to the inside of the scrotum by a membrane, preventing them from rotating. However, with the bell clapper deformity, the testicle is not properly attached and hangs more freely within the scrotum, similar to how a bell hangs from its clapper. This allows the testicle to twist on the spermatic cord.

While the bell clapper deformity is the most common underlying cause, other factors can contribute to or trigger testicular torsion:

• Anatomical Factors: Besides the bell clapper deformity, other less common anatomical variations can increase susceptibility.
• Trauma or Injury: A direct blow to the scrotum or even minor trauma, such as during sports or vigorous physical activity, can sometimes initiate the twisting. This is more likely to happen if the underlying anatomical predisposition exists.
• Sudden Movements: Certain sudden movements or positions, like those encountered during sports or even in sleep, can sometimes cause the testicle to twist.
• Cryptorchidism (Undescended Testicles): While less common, males with undescended testicles may have a slightly increased risk of torsion, particularly if the testicle is located in the inguinal canal.
• Temperature Changes: Although not a primary cause, some reports suggest that extreme cold temperatures might cause the cremaster muscle (which pulls the testicles closer to the body) to contract, potentially increasing the risk of torsion in susceptible individuals. However, this is not a widely accepted direct cause.

Who is at Risk for Testicular Torsion?

Testicular torsion is most common in adolescent boys and young men, typically between the ages of 12 and 18. However, it can occur at any age, including in newborns and older adults. Males with a family history of testicular torsion or those who have had previous testicular surgery may also be at a higher risk.

Symptoms of Testicular Torsion

The hallmark symptom of testicular torsion is sudden, severe pain in one testicle. Other common symptoms include:

• Swelling of the scrotum
• Abdominal pain
• Nausea and vomiting
• A testicle that is higher than the other or lies at an unusual angle
• Fever (less common)

It is crucial to remember that not all testicular pain is torsion, but any sudden, severe testicular pain should be evaluated by a medical professional immediately. Delaying treatment can significantly increase the risk of permanent damage to the testicle.

Diagnosis and Treatment

Diagnosis is typically made based on a physical examination and the patient's symptoms. In some cases, an ultrasound with Doppler imaging may be used to assess blood flow to the testicle. Treatment for testicular torsion is surgical. The goal is to untwist the spermatic cord to restore blood flow and to surgically secure both testicles to prevent future torsion events. This procedure is called orchiopexy.

If blood flow has been cut off for too long, the testicle may not be salvageable and may need to be removed (orchiectomy). Prompt medical attention is essential to maximize the chances of saving the testicle.