What is Testicular Torsion?

First of all, it is necessary to explain Acute Scrotum.

Acute Scrotum; The testicle becoming swollen, painful and red is called ‘acute scrotum’. The most important factor causing this is Testicular Torsion. It is when the testicle rotates around itself (torsion) and its vessels become unable to provide blood circulation to the testicle.

Testicular torsion or torsion of testicular appendages occurs in 1/160 of men. Testicular torsion alone is 1/4000. Testicular torsion is most common during puberty and second most common around the age of one year. Left testicular torsion is more common. Bilateral testicular torsion is present in 2 percent of cases. Testicular torsion accounts for 30% of patients presenting to the clinic with acute scrotum.

What Problems Does Testicular Torsion Cause?

As a result of the testicle rotating around itself, testicular blood supply is disrupted and a pathology leading to necrosis (testicular decay) occurs. If the diagnosis is not made in the first 8 hours and surgical treatment is not performed, the risk of necrosis (testicular decay) is much higher because the testicle cannot be blooded.

However, testicular rotation does not always end with testicular necrosis. Sometimes testicular rotation may resolve spontaneously. The degree of rotation and the time it takes to correct it are important in the formation of necrosis.

What are the causes of testicular torsion?

There may be several reasons for this. Especially the testicle is attached to the scrotum and surrounding tissues with some anatomical structures. Some anatomical problems in these can cause testicular torsion.

Trauma and excessive physical activity can stimulate the cremaster muscle and cause testicular rotation.

The high rate of testicular rotation during puberty is thought to be the result of the testicle growing faster than neighboring organs with the effect of testosterone hormones.

Are there any diseases that cause a clinical picture similar to testicular torsion?

Yes, there are. These include;

1. Testicular or epididymal appendix torsion: There are 1-10 millimeter diameter extensions (appendages) called appendix testis on the testicle and epididymis. As a result of their rotation, pictures mimicking testicular torsion may occur. Rotation of these appendages is more common around the age of 11. In this period, appendix testicular torsion is thought to be related to the release of estrogen hormone. The diagnosis is easily made by specialists and the treatment is medication. There is no need for surgery.
2. Epididimo-Orchitis; Inflammation of the epididymis and testicle (epididymo-orchitis) or inflammation of only the epididymis (epididymitis) can be confused with testicular rotation. Epididymitis usually occurs before puberty. Epidididimo-Orchitis is usually seen after puberty. Diagnosis is based on clinical, doppler USG, urine and blood tests. Treatment is follow-up and medication, no need for surgery.
3. Fat necrosis seen in overweight children is also compared to testicular rotation.
4. Scrotal edema of unknown cause
5. Inguinal Hernia and Water Hernia
6. Varicocele
7. Trauma
8. Some Blood Diseases (Henoch-Schölein Purpura
9. The first finding of Lymphoma and Leukemia can sometimes be Acute Scrotum.

What are the Clinical Features of Testicular Torsion?

The most important finding in testicular torsion is sudden onset of severe pain in the testicle, groin and lower abdomen. Nausea is also seen in 25 percent of patients. Approximately 25 percent of the cases diagnosed with testicular torsion have a history of pain in the scrotum due to testicular rotation several times before. Redness of the skin and mild edema are observed.

Increasing darkening of the skin color is observed. The intensity of the pain increases when the testicle is lifted upwards by hand and brought closer to the body. In delayed cases, the pain may decrease as the testicular tissue decays.

In addition, in physical examination, cramster muscle reflex disappears, testicle torsion, torsion-related pulling is seen at the base of the scrotum, pain changes when the testicle is lifted upwards.

How is Testicular Torsion Diagnosed?

Testicular torsion is diagnosed by history and physical examination. However, this diagnosis may need to be confirmed with some tests. These are; Blood test, urinalysis, Doppler Ultrasonography and Scintigraphy. However, there are two problems in performing these examinations, the first is the loss of time and the second is that all these examinations cannot distinguish testicular torsion from orchioepididymitis. Testicular torsion requires emergency surgery.

How is Testicular Torsion Treated?

Testicular torsion is a very urgent disease that should be considered in scrotal pain, swelling and redness (acute scrotum) in children. If there is no urgent intervention in full rotation of the testicle, the testicle goes to necrosis (decay).

In an emergency surgery, the testicle is rotated in the opposite direction and returned to its normal shape. Within a few minutes after the testicle is returned to normal, it is seen that the testicular blood supply returns to normal. Both testicles should be checked during testicular rotation surgery. During the operation, the normal testicle should also be sutured to fix it to the surrounding tissues. If the color does not lighten after the testicle is returned to normal and there is a suspicion that the circulation is not fully restored, the testicle is left in place in children under 10 years of age. In children older than 10 years of age, removal of the testicle is recommended. Because a necrosed testicle can also damage the testicle of the other side.

Can Testicular Torsion Be Corrected Without Surgery?

This (i.e. manual correction) is possible in adults, but is not practical in children.

What is Torsion of the Appendix Testis and Epidididymis?

It is the rotation of the Appendix Testis and Epidididymis around itself. The cause is not known exactly. The clinic is similar to testicular torsion, the time of presentation may be late, there is point tenderness and there is a blue dot symptom.

Diagnosis; It is diagnosed as in testicular torsion.

Treatment; Local cold application, rest (physical activity may increase symptoms), painkillers and anti-inflammatory improves in a few days. However, if it cannot be separated from definite Testicular Torsion, Surgery is applied.

What is Epididymal Orchitis?

It is an infection of the anatomical structure called testicle and epididymis. The exact incidence is not known due to the difficulty in diagnosis. It is the most common cause of acute scrotum in children. The cause may be viral (e.g. mumps) or bacterial.

Clinical complaints develop slowly compared to testicular torsion and the pain is usually more dull, sometimes there may be systemic findings such as Urinary Tract Infection and its symptoms. Urinary system anomaly should be considered especially in cases of recurrent orchioepididymitis.

Diagnosis is the same as in Testicular Torsion. Cynicism is less noisy here. Testicle is in normal position, Cramesteric Reflex is preserved.

Treatment; Rest, Painkillers and Antieflematory treatment is sufficient for treatment. However, if the agent is viral, there is no need for antibiotics.

What is Acute Idiopathic Scrotal Edema?

The cause is unknown. There is edema and redness in the scrotum. It is usually seen in children aged 2-10 years and testicles are not affected, pain may be present. Diagnosis is made by history, physical examination and ultrasonography. Treatment is follow-up but sometimes painkillers may be required.

Testicular Trauma

It usually develops due to blunt trauma. Pain, redness and swelling occur in the scrotum.

Diagnosis; History, physical examination and Doppler Ultrasonography.

Treatment; Follow-up, painkillers and sometimes surgery may be required

*** The information provided here, the content of the website is intended to inform the visitor, especially families. No information should be considered as advice by visitors and should not lead to any decision or action. Families should definitely have their patient examined by a pediatric surgery specialist, consult with him/her and make a decision by consulting his/her knowledge one-on-one.