Testicular Torsion

Testicular torsion is a rare but serious medical condition that often requires emergency surgery. The testicles are the male reproductive organs located behind the penis, inside the scrotum, and produce hormones and sperm. Testicular torsion occurs when a testicle rotates on the “spermatic cord.” The spermatic cord is responsible for supplying blood flow to the scrotum and testicles from the abdomen. When the testicle rotates, it can twist the spermatic cord and subsequently reduce or cut off the blood supply to that testicle. If the blood flow is cut off for too long, the testicle could die.

Symptoms

The reduced blood flow that occurs during testicular torsion usually causes sudden and severe pain and swelling in the affected testicle. Other symptoms of testicular torsion include:

• A visible lump on one testicle
• Nausea and vomiting
• Discoloration of the scrotum (typically red, purple, brown, or black)
• One testicle positioned higher in the scrotum than the other (retracted) or positioned at an unusual angle
• Abdominal pain
• Frequent urination
• Fever

Most people who experience testicular torsion report feeling a sudden, intense pain in the testicle, sometimes extending into the stomach area, or making the person feel nauseous. The pain may even cause the person to have trouble walking. Some people have reported feeling intense pain in the affected testicle that goes away and then comes back later.

Testicular torsion almost always occurs in one testicle (most commonly the left testicle), but can occur in both testicles in rare cases. Only about 2% of testicular torsion cases affect both testicles.

Causes and Risk Factors

Testicular torsion is rare, affecting about 1 in 4,000 males under the age of 25. It typically occurs in males between the ages of 12 and 18 and can occur several hours after strenuous activities, after a minor injury to the testicle, or, more commonly, during sleep. However, it is usually a spontaneous event with no apparent cause and can happen to anyone with testicles at any time.

Most commonly, testicular torsion occurs in people who have an inherited condition called bell clapper deformity. Most males without this deformity have tissue surrounding their testicles that attaches them to the scrotum. When the testicles are well attached to the scrotum, they cannot freely twist or rotate. However, people with bell clapper deformity have no tissue holding their testicles to their scrotum. As a result, their testicles hang freely inside the scrotum, allowing them to swing and rotate.

Other factors that may increase the risk of testicular torsion include the following:

• Family history of testicular torsion
• Previous testicular torsion or intermittent torsion and detorsion
• Cold temperatures
• Rapid growth of the testicle(s) during puberty

Diagnosis

Early diagnosis and immediate treatment of testicular torsion are key to preventing irreversible damage and loss of the testicle. If a testicle dies from lack of blood flow, it will need to be surgically removed. The risk of losing a testicle drastically increases within just 6 hours of the onset of testicular torsion; most people will need to have the affected testicle removed after about 12 hours. If treatment is delayed for more than 24 hours, there is only about a 10% – 18% chance that the testicle will still be viable. Even when the testicle can be saved, delayed treatment can increase a person’s risk of additional complications such as a lower sperm count and infertility.

Testicular torsion can be diagnosed according to a person’s medical history, symptoms, physical examination, and certain tests. However, symptoms and clinical findings of testicular torsion can vary and a diagnosis can be easily missed or delayed by emergency department providers. For this reason, medical providers should always consider a testicular torsion diagnosis when a patient presents with any symptoms. A urologist consultation should also be obtained quickly, when possible.

The following exams and medical testing may be conducted by a medical provider whenever there is reason to suspect testicular torsion:

Physical Exams:

Medical providers should conduct a thorough examination of the patient’s abdomen, groin, testicles, and scrotum whenever symptoms of testicular torsion are reported or if a testicular torsion diagnosis is suspected or being considered. During the examination, the patient’s reflexes may be tested by lightly pinching or rubbing the inside of the patient’s thigh. Typically, this would cause a testicle to contract. However, the reflex may not occur in patients experiencing testicular torsion (although the presence of this reflex cannot rule out testicular torsion).

If findings from the physical exam suggest a high suspicion of testicular torsion, and symptoms have already been present for several hours, the patient may be taken directly to surgery to prevent any further delay in treatment.

However, it is important to note that there is no single physical exam that can provide a definitive diagnosis or that can definitively rule out testicular torsion. It is not unheard of for testicular torsion to present as only mild discomfort, or as an isolated complaint of abdominal pain in some patients. The variety of symptoms and circumstances that patients with testicular torsion may experience (and the potential for them to experience atypical symptoms associated with other conditions) can lead to misdiagnoses such as epididymitis or appendicitis when medical providers rely on initial impressions or a single negative exam result.

Imaging and Additional Tests:

Given the high risk of losing a testicle and the importance of a timely diagnosis, medical providers should aggressively pursue a testicular torsion diagnosis until it can be ruled out for certain. This may include conducting additional tests to check for or confirm testicular torsion, or to identify other potential causes for a patient’s symptoms.

• Scrotal Ultrasound: A scrotal ultrasound is a quick imaging test that allows medical providers to see the organs in the pelvic area and may be used to check blood flow within the testicular tissues. This test can be very helpful in detecting the decreased blood flow associated with testicular torsion. Medical providers should consider ordering a scrotal ultrasound whenever there is a reasonable suspicion of testicular torsion. However, this test may not always detect reduced blood flow. Reports may sometimes produce false negative findings and can be misread by radiologists. A negative scrotal ultrasound report should not be used alone to rule out testicular torsion. When there is a clinical suspicion of testicular torsion, but the ultrasound report is negative or unremarkable, a urologist should be consulted.
• Urine Test: A urine test may be used to check for underlying infections and other potential causes for a patient’s symptoms.
• Surgery: Sometimes surgery may be necessary in order to determine or confirm whether a patient’s symptoms are due to testicular torsion or another condition.

Treatment

Treatment for testicular torsion often requires a surgery typically referred to as an “orchiopexy.” In most cases, the surgery is performed through a small incision in the scrotum and is completed in less than an hour. During surgery, the spermatic cord will be untwisted and the affected testicle(s) will be examined by the surgeon to determine whether it is still viable. If the testicle is able to be saved, the surgeon will secure the testicle to the inside of the scrotum with stitches to prevent it from twisting and causing testicular torsion to occur again in the future. For people with bell clapper deformity, the surgeon will also stitch the unaffected testicle to the inside of the scrotum to prevent testicular torsion from occurring in that testicle.

If the testicle dies prior to surgery, or the surgeon finds that the testicle is too severely damaged and has lost its ability to function, the surgeon will likely need to remove the testicle during surgery. If this is the case, the surgeon may discuss options with the patient such as replacing the testicle with a testicular prosthesis.

In order to quickly return blood flow to a testicle prior to surgery and increase the chances that it can be saved, a medical provider may sometimes be able to push on the scrotum and untwist the testicle through “manual detorsion.” However, this treatment is not a corrective fix for testicular torsion. Surgery will still be necessary to correct testicular torsion and to prevent it from occurring again.

Testicular Torsion in Newborns

Although it is rare, testicular torsion can occur in newborn babies and often results in a loss of the testicle. Symptoms can include when the infant is born with a testicle that is darker in color, swollen, or hard. However, surgery may be needed to confirm a testicular torsion diagnosis in a newborn, as ultrasounds might not be able to detect reduced blood flow in a newborn’s scrotum.

Treatment for testicular torsion in newborns is controversial due to the risks associated with general anesthesia. If the infant is born with symptoms, it may also be too late for emergency surgery to provide any benefit. However, in some cases, emergency surgery can save a newborn’s testicle and prevent testicular torsion from occurring in the unaffected testicle. Treatment may also prevent future issues with fertility and male hormone production.

Filing a Medical Malpractice Claim or Lawsuit

If you or a family member has suffered complications from testicular torsion that was negligently diagnosed or treated, you may be entitled to compensation for your damages. Call Bonner Law at 1-800-4MEDMAL or visit our page for a free consultation.

Medical malpractice cases are complex and can be emotionally challenging for the patients involved. Finding the right attorney can make the process much easier. Michael P. Bonner has over 30 years of experience representing patients in medical malpractice cases all over Florida. Bonner Law has the knowledge and experience to represent you and navigate the legal and medical landscape to ensure that you receive compensation for damages, including medical bills, lost wages, and pain and suffering that you are entitled to. For more information on medical malpractice claims you can also visit our Medical Malpractice page.