Testicular Torsion

Testicular torsion occurs when there is a rotation of the sperm duct that causes the blood supply to the testicle to become obstructed. It is an absolute emergency and must be evaluated and treated by a professional within six hours since that is the maximum time the testicle can be kept without irrigation. After six hours, 90% of the testicles should be removed.

The patient with testicular torsion refers to scrotal pain radiating into the pelvis that starts suddenly, nausea, and vomiting. On examination, one testicle may be found to be higher than the other. It is important to maintain a periodic evaluation of the testicles to see if there is anything different about them. I recommend performing a testicular self-examination by palpating the scrotum for masses and then following the surface of each one.

Richard M.2020, Own work, CC BY-SA 4.0

The cremasteric reflex is an involuntary retraction response of the scrotum to the stimulus of rubbing the inner thigh. This reflex is lost when there is testicular torsion. In one type of testicular torsion, the spermatic cord does not completely rotate but has a back-and-forth motion, so there may be relief with acute periods of pain. The testicle will have approximately six critical hours (known in surgery as “golden hours”) before irreversible damage starts because of blood flow compromise. This case should be considered an emergency as well because treatment will be surgical. In the case of not being able to make it to an emergency department, manual detorsion will be the best option.

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