Testicular torsion

Definition/diagnostic criteria Testicular torsion is a urological emergency characterised by the twisting of the spermatic cord, leading to compromised blood flow to the testicle. This results in ischaemia and, if left untreated, can lead to irreversible testicular damage.

The diagnostic criteria for testicular torsion include sudden onset of severe testicular pain, often accompanied by nausea and vomiting. Patients may also report a history of recurrent scrotal pain, which could indicate intermittent torsion.

Epidemiology Testicular torsion primarily affects males between the ages of 12 and 18 years but can occur at any age. It is a relatively rare condition, with an incidence of approximately 1 in 4,000 males under the age of 25. The condition is more common in Caucasians than in other ethnic groups.

Testicular torsion is often associated with anatomic predispositions, such as a high insertion of the tunica vaginalis or the presence of a “bell-clapper” deformity, where the testicle is not adequately anchored within the scrotum.

Diagnosis The diagnosis is made clinically.

• The clinical hallmark of testicular torsion is severe, sudden-onset scrotal pain.
• The pain may be localised to one testicle and is often accompanied by swelling and tenderness of the affected testicle.
• Nausea and vomiting are common due to the intensity of the pain.
• The cremasteric reflex may be absent.

Treatment Immediate intervention is essential in cases of suspected testicular torsion, as the longer the delay in treatment, the higher the risk of testicular loss. The mainstay of treatment is surgical detorsion and fixation of the affected testicle to prevent recurrence.

Prognosis The prognosis for testicular torsion depends largely on the duration of torsion before intervention. If treated within 4-6 hours, the majority of patients will have a good outcome with preservation of testicular function. However, delays in treatment beyond this timeframe significantly increase the risk of testicular loss.