Testicular ischemia

Definition

Testicular torsion is the twisting of the spermatic cord, which cuts off the blood supply to the testicle and surrounding structures within the scrotum.

Alternative Names

Causes

Some men may be predisposed to testicular torsion as a result of inadequate connective tissue within the scrotum. However, the condition can result from trauma to the scrotum, particularly if significant swelling occurs. It may also occur after strenuous exercise or may not have an obvious cause.

The condition is more common during infancy (first year of life) and at the beginning of adolescence (puberty).

Symptoms

• Sudden onset of severe pain in one testicle, with or without a previous predisposing event
• Swelling within one side of the scrotum (scrotal swelling)
• Nausea or vomiting
• Light-headedness

Additional symptoms that may be associated with this disease:

• Testicle lump
• Blood in the semen

Exams and Tests

• Extremely tender and enlarged testicular region -- more common on the right
• The testicle on the affected side is higher

Treatment

Surgery is usually required and should be performed as soon as possible after symptoms begin. If surgery is performed within 6 hours, most testicles can be saved.

During surgery, the testicle on the other (non-affected) side is usually also anchored as a preventive measure. This is because the non-affected testicle is at risk of testicular torsion in the future.

Outlook (Prognosis)

If the condition is diagnosed quickly and immediately corrected, the testicle may continue to function properly. After 6 hours of torsion (impaired blood flow), the likelihood that the testicle will need to be removed increases. However, even with less than 6 hours of torsion, the testicle may lose its ability to function.

Possible Complications

If the blood supply is cut off to the testicle for a prolonged period of time, it may atrophy (shrink) and need to be surgically removed. Atrophy of the testicle may occur days-to-months after the torsion has been corrected. Severe infection of the testicle and scrotum is also possible if the blood flow is restricted for a prolonged period.

When to Contact a Medical Professional

Go to the emergency room or call the local emergency number (such as 911) if testicular torsion symptoms occur.

Prevention

Use precautions to avoid trauma to the scrotum. Many cases are not preventable.

Expert Panel on Urologic Imaging. Acute onset of scrotal pain (without trauma, without antecedent mass). Reston, Va: American College of Radiology; 2005. 4 p.

Ringdahl E. Testicular Torsion. Am Fam Physician. Nov 2006; 74(10): 1739-43.

Wein AJ. Campbell- Walsh Urology. 9th ed. St. Louis, Mo: WB Saunders; 2007.

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