Testicular Torsion – Diagnosis and Treatment
Diagnosis
When someone has sudden and severe scrotal pain or swelling, doctors look for signs of testicular torsion.
The health provider examines the scrotum, testes, abdomen, and groin for swelling, unusual positioning, or tenderness.
Doctors check the cremasteric reflex by rubbing or pinching the inner thigh to see if the testicle lifts.
An absent reflex on one side can suggest torsion. During the exam, doctors look for other signs like scrotal swelling or a high-riding testicle.
If needed, doctors use several tests to confirm the diagnosis:
| Test | Purpose |
|---|---|
| Urine Test | Checks for infection. |
| Scrotal Ultrasound | Looks at blood flow to the testicle. |
| Surgery | Finds direct cause if diagnosis is unclear. |
Doctors often use scrotal ultrasound with color Doppler to check blood flow. Loss of normal flow can signal torsion, but sometimes this test misses the problem.
If doctors strongly suspect testicular torsion and pain has lasted for hours, they may take the patient to surgery right away to save the testicle.
Additional Details:
A healthcare provider may also check for features like the bell-clapper deformity or the blue dot sign, but these do not always occur.
Treatment
Testicular torsion can occur in newborns and infants, although it is rare. Signs include a swollen, firm, or oddly colored scrotum.
Ultrasound may not always detect the problem, so doctors often rely on surgery for diagnosis and treatment.
Treatment steps may include:
- Surgery under anesthesia to explore the scrotum.
- Untwisting the spermatic cord (detorsion), if possible.
- Securing both testicles to the scrotum wall (orchiopexy) to prevent future twisting.
If the testicle has been twisted for too long, doctors may need to remove it (orchiectomy).
| Symptom | Possible Treatment |
|---|---|
| Swelling, discoloration | Surgical exploration |
| Hard, painful testicle | Surgery is typical; manual detorsion is rarely effective. |
| Nausea or vomiting | Supportive care and address underlying torsion. |
Doctors consider timing and risks before deciding on emergency surgery, especially for newborns. If surgery happens soon after symptoms start, there is a better chance of saving the testicle.
Note: Distinguishing between extravaginal torsion (common in infants) and other causes can affect decisions about surgery.
Getting Ready for Your Visit
Steps You Can Take
Preparing ahead helps you get the most out of your healthcare visit. Make a list of your symptoms, including when they started, how they feel, and what affects them.
Write down any questions you want to ask. This helps you remember important topics during your appointment.
Some possible questions include:
- What causes testicular torsion?
- Could anything else be causing my symptoms?
- What happens if I do not have the surgery?
- What risks are involved with surgery?
- Will there be activity restrictions after surgery?
- When is it safe to be sexually active again?
- Will my ability to have children (fertility) be affected?
- Can this problem happen again?
Add any other questions or concerns you have. Writing things down helps you feel prepared and ensures you get the information you need.
Bring a list of any medicines you take. If you have had similar symptoms or testicular problems before, note this as well.
Tip: If you feel nervous, bring a friend or family member for support and to help remember what the doctor says.
Questions Your Healthcare Provider May Ask
The healthcare provider will ask questions to understand your situation. Being ready to answer helps the appointment go smoothly.
They may ask:
| Possible Questions | What They Want to Know |
|---|---|
| When did your symptoms begin? | Find out how long the problem has been going on. |
| What were you doing when symptoms started? | See if activity was a factor. |
| Have symptoms been constant or on and off? | Learn if the pain comes and goes. |
| How severe is your pain? | Understand how much discomfort you feel. |
| Does anything make symptoms worse or better? | Find triggers or relief. |
| Has anyone in your family had similar problems? | Check for family risk. |
| Have you had this happen before? | Find out if it is a repeat event. |
The provider might do a brief physical exam and ask about your general health, past injuries, or other illnesses.
Doctors often ask about fertility because people worry about their ability to have children after testicular torsion. Be honest about your concerns and history so your doctor can give you the best advice.
Having information ready helps you and your healthcare provider. It can lead to faster care and better results.
Further Details
Testicular pain can have different causes. It is important to tell the difference between testicular torsion and other conditions, like epididymitis.
Doctors look for symptoms such as swelling, redness, or hard spots in the scrotum. Sometimes, the appendix testis, a small tissue near the testicle, can twist and cause pain similar to torsion.
Doctors often order a urinalysis to check for infection, which may point to epididymitis instead of torsion. Some causes of pain need emergency care, so quick diagnosis is important.
| Condition | Main Symptom | Possible Signs | Helpful Test |
|---|---|---|---|
| Testicular Torsion | Sudden pain | Swelling, severe tenderness | Ultrasound |
| Epididymitis | Gradual pain | Redness, fever, pain | Urinalysis |
| Appendix Testis Pain | Local pain | Small lump on testicle | Physical Exam |
Doctors use these signs and their judgment to find the right cause of pain.
