TUESDAY, March 19, 2024
nationthailand

Testicular torsion: An acute pain not to neglect

Testicular torsion: An acute pain not to neglect

Affecting mainly adolescents and young adults, testicular torsion, the acute twist of one testicle, is one of the most frequent surgical emergencies among younger individuals and one that must be promptly treated to save the genital organ and preserve fer

Parents and educators must be aware of this condition, which statistics put as occurring in one out of 4,000 males under the age of 25.
The testicles are two identical genital glands located inside the scrotum, the bag behind the penis. The organ produces hormones such as testosterone and sperm cells (spermatozoa), the male cells that can fertilise an ovum (or female cell) to form an egg that subsequently develops into an embryo. Testicles are normally surrounded by a tied membrane and well attached inside the scrotum to the spermatic cord that contain vessels, muscle and the tube carrying the sperm. 
Torsion occurs when an inherited membrane defect or anatomic abnormality allows the testicle to twist around the spermatic cord. This leads to an abrupt interruption of blood supply to the testis that can, without early treatment, irreversibly damage the testicular function, especially sperm viability as well as, albeit moderately, the hormonal synthesis. A twist can be partial or total and can in some cases resolve itself. At any rate, any torsion of the testicle can significantly harm the organ function and always requires urgent specialist opinion. 
Typically, the main symptom is a spontaneous, acute, rapidly intense pain in one testicle associated with swelling, redness and tenderness of the scrotum. The pain may irradiate towards the groin, impair the walking or trigger a malaise with nausea and vomiting. The testicle is often in an abnormal position. 
The torsion can occur anytime but is more often seen during sleep (the person being suddenly awakened by a severe pain), after strenuous exercise or trauma.
 The peak age is 16. In 65 per cent it occurs at puberty when the volume of the testicles rapidly increases. Ten per cent of cases are among infants in the first year of life and while it is rare after reaching 40, it can still happen, even among the elderly. Boys who had one undescended testis in the scrotum have a 10-fold higher risk of twisting. Testicular torsion can also occur during the foetal period meaning that the newborn might present a totally destroyed gland. 
Diagnosis is essentially based on the symptoms and clinical exam. An ultrasound of scrotum may be needed in some doubtful cases. At any rate, the occurrence of any painful testicle syndrome must be immediately evaluated by an urologist or paediatric surgeon to confirm the diagnosis (which may need surgical exploration) or rule out testicular torsion. 
In the case of a minor and incomplete twist, the specialist may be able to manually perform a detorsion of the spermatic cord but surgery is still indicated to prevent further torsion. The surgical procedure is aimed at attaching both testis – the affected one and also the contralateral one – to avoid recurrence. 
If corrected within three hours, recovery of the testicle function is 100 per cent, dropping to 90 per cent if the lead-time for surgery is less than 6 hours. Its falls to 50 per cent after 10 hours and to 10 per cent only after 48 hours. 
However, despite the frequent possibility of conserving the gland, the fertility of the patient could be partially compromised despite unilateral torsion. In late treatment, the badly damaged testicle has to be removed.
Every adult needs to be aware of the inherent risks of acute testicular pain and promptly orient the patient to a specialised surgical care. 
 
DR GERARD LALANDE is managing director of CEO-Health, |which provides medical referrals for expatriates and customised |executive medical check-ups in Thailand. He can be contacted at |[email protected]
 
nationthailand