Dangers of extreme physical activity; know more about Testicular Torsion

Testicular torsion happens when the testicle twists around the spermatic cord, which contains blood vessels, nerves, and the vas deferens (the tube that carries sperm from the testicles to the urethra). This twisting cuts off the blood supply to the testicle, leading to severe pain and swelling. Testicular torsion is a surgical emergency that if left untreated can result in irreversible damage.

Causes of Testicular Torsion:

Testicular torsion happens when the testicle twists around the spermatic cord, which supplies blood from the abdomen to the testicle. If the twisting is severe, it can completely obstruct blood flow, causing irreversible damage.

Many males who experience it have an inherited condition that allows the testicle to move freely within the scrotum, often affecting both testicles. However, not everyone with this condition will develop testicular torsion.

This condition frequently arises hours after strenuous physical activity, following a minor injury to the testicles, or during sleep. Factors such as cold weather or the rapid growth of the testicles during puberty may also contribute.

The exact cause of testicular torsion is often unknown, but several factors may contribute to its occurrence:

1. Bell Clapper Deformity: This congenital condition allows the testicles to move more freely within the scrotum, increasing the risk of torsion.
2. Physical Activity: Sudden movements or trauma to the groin area can trigger torsion.
3. Age: Testicular torsion is most common in males between the ages of 12 and 18, but it can occur at any age.
4. Family History: A family history of testicular torsion may increase the risk.

Symptoms of Testicular Torsion

The symptoms of testicular torsion can be sudden and severe, including:

• Severe Pain: Sudden, intense pain in one testicle.
• Swelling: Swelling of the scrotum.
• Nausea and Vomiting: Often accompanies the pain.
• Abdominal Pain: Pain may radiate to the lower abdomen.
• Redness or Darkening of the Scrotum: The affected area may become red or dark.

Diagnosing Testicular Torsion

If testicular torsion is suspected, immediate medical attention is necessary. A physician typically performs a physical examination and may order imaging tests such as an ultrasound to confirm the diagnosis. Time is critical; the sooner the diagnosis is made, the better the chances of saving the testicle.

Treatment Options

The primary treatment for testicular torsion is surgery, known as orchiopexy. The goals of surgery are to untwist the spermatic cord, restore blood flow, and secure the testicle to prevent future torsion.

1. Emergency Surgery: The affected testicle is untwisted, and both testicles are usually attached to the scrotum to prevent recurrence.
2. Testicle Removal: If the blood supply has been cut off for too long, the testicle may be damaged beyond repair and need to be removed.

Prevention and Aftercare

While testicular torsion cannot always be prevented, those with a family history or known risk factors should be vigilant. Regular self-examinations and prompt medical attention if symptoms occur can improve outcomes. After surgery, most individuals can return to normal activities, but follow-up care is essential to monitor recovery and prevent complications.

Conclusion

Testicular torsion is a surgical emergency that almost always presents to the emergency department. The disorder is usually managed by urologists/surgeons.

The first person to encounter the patient is the triage nurse, who must be familiar with the symptoms of the disorder. Time is of the essence, and the nurse should be aware of torsion, quickly admit the patient, and promptly notify the ED physician. The ED physician should consult with a radiologist for the appropriate test and, at the same time, consult with a urologist. The nurses should prepare the patient as if he will be going for surgery by keeping him NPO and having all the necessary blood work completed.

If the testing confirms torsion, the urologist/surgeon is usually required to perform the surgery. The nurse should educate the family and the patient about the potential complications, including loss of the testis and infertility. The nurse should ensure that the patient is administered no food or drink by mouth and is prepared to go for urgent surgery. More importantly, the nurse should avoid giving any pain medications until the patient has been seen by the urologist, as pain medication can mask the symptoms and delay the diagnosis. Only through a systematic approach to diagnosis and treatment is the salvage of the testis possible.

Testicular torsion is a serious condition that requires immediate medical attention. Understanding the causes, recognizing the symptoms, and seeking prompt treatment can significantly impact the prognosis. Awareness and education are key to ensuring timely and effective care, ultimately preserving testicular health and function.

The writer is a Senior Consultant, Urology & Andrology at Apollo Adlux Hospital, Angamaly, Ernakulam