Understanding the testes
The two testes lie in the scrotum. The spermatic cord is like a flexible tube that goes from each testis to the lower abdomen. The spermatic cord contains the blood vessels that take blood to and from the testis, and the vas deferens which takes sperm from the testis to the penis.
You can normally feel the spermatic cord through the skin of the scrotum just above the testis. It feels like a thick piece of string. The testes can move around a little in the scrotum, but cannot usually move enough to twist round fully.
What happens in a torsion (twisting) of the testis?
In some people the tissues that surround the testis in the scrotum are lax. Therefore, the testes can move around in the scrotum more than usual. If a testis twists around, the spermatic cord has to twist around too as it is fixed higher up. If this happens, the blood flow to the testis is blocked in the twisted spermatic cord. (This is like a hose-pipe attached to a tap. The water will not flow if the hose gets twisted on itself.)
A testis with its blood supply cut off is likely become damaged and die unless the blood flow is quickly restored.
Who gets torsion of the testis?
It most commonly occurs in teenage boys, shortly after puberty. Newborn babies and younger children sometimes develop this problem. It is uncommon over the age of 25, but does occur sometimes in older adults.
What are the symptoms of torsion of the testis?
The typical symptom is severe pain that develops quickly – within a few hours, often much more quickly. The pain is in the affected testis, but you may also feel it in the middle of the abdomen (due to a shared nerve supply). In about half of cases, symptoms start in the night, and the pain wakes you from sleep. The affected testis soon becomes tender, swollen, and inflamed.
What is the treatment for torsion of the testis?
Torsion of the testis is an emergency. If the blood supply to the testis is cut off for more than about six hours, then permanent damage to the testis is likely to occur. An emergency operation is usually done. A small cut is made in the skin of the scrotum to expose the testes. The affected testis and spermatic cord are untwisted. The testis is then stitched to the surrounding tissue and fixed in position to prevent torsion happening again. The other testis is also fixed at the same time as it has a higher-than-average chance of twisting in the future.
The sooner the operation is done, the better the outlook to save the testis. Ideally, the operation should be done within 6-8 hours of symptoms starting. Sometimes the affected testis is removed if the operation is done too late and the testis has died.
Although the operation is usually done as an emergency, it is a fairly small operation which does not take very long. Occasionally, the twisted testis can be untwisted by a doctor without needing an operation. However, this procedure is painful and not often successful. An operation is usually needed.
Partial torsion and warning pains
Some boys and men have warning pains in a testis every now and then, before a full-blown torsion. These occur suddenly, last a few minutes, then ease just as suddenly. These pains occur if a testis twists a little, and then returns back to its normal place on its own.
An operation to fix the testes in place is usually advised if these warning pains occur. This is because it is likely that at some point a testis will twist fully, and emergency surgery will be needed. A planned operation to fix the testes is preferable than waiting for a full-blown torsion to occur.
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