Testicular torsion is an emergency situation, an acute scrotal condition, which causes intense pain of sudden onset in the testicle and which occurs more commonly in young boys in prepubertal age or in adolescence. In these cases, the speed in going to the emergency room is vital to save the functionality of the testicle.
Testicular torsion
As explained by Dr. César Vargas, president of the Catalan Society of Urology, testicular torsion is caused by a sudden contraction of the cremaster muscle that goes from the testicular cord to the scrotum.
“It is a more active muscle at this time of life and due to a sudden contraction it can rotate the testicular cord, strangling it and obstructing the passage of blood to the testicle, which causes a lack of vascularization that can lead to necrosis”, explains Dr. Vargas.
Testicular torsion can occur in the child from 8 or 9 years old. It is diagnosed by the clinic (symptoms), the examination is difficult due to the pain that palpation of the testicle causes and the ultrasound can also be helpful.
The cremaster muscle is more active in young boys.
The cremaster muscle is more active in young boys, with age it becomes more lax and does not contract as much, although older adults can also suffer from testicular torsion. It is rare for it to be caused by a blow while playing a sport and it can happen at night while sleeping or due to sexual stimulation.
“It is not uncommon and The most important thing is to go quickly to the emergency room. There are people who wait to see if the pain resolves, but if there is ischemia and the blood does not arrive, it is an emergency situation because after a few hours the testicle cannot be recovered,” says the urologist.
After 6 hours there are no guarantees that the testicle can be saved, so you have to go to the emergency room. If not many hours have passed, manipulations can be performed to eliminate the torsion, but this is possible in a very small number of cases, generally requiring surgical action.
A minor but vital surgery
The indication is surgical and during the operation, in addition to eliminating the torsion of the cord, the testicle is fixed in its place, since it is usually people with a certain predisposition to testicular torsion.
There may be cases in which the torsion is incomplete and some blood reaches the testicle, but the torsion is usually complete. If it operates within the 6-hour time window is recovered the function of the testicle, generally at 100%, as this time interval increases it is more difficult to recover the testicle, and if the torsion is complete and more than 12 hours are exceeded, it will be difficult to recover.
The intervention sand performed under anesthesia but it does not require a stay in the hospital and it is only advised not to exercise during the following week. Locoregional (epidural) anesthesia is used for the surgical act of removing the torsion of the testicular cord and placing it in its normal situation, and stitches are given to fix both testicles and prevent a new torsion.
If the testicle is lost, the testicular function is maintained with the other, but out of prudence the other is fixed to prevent it from suffering posterior torsion, for this it is fixed to the muscle of the wall inside the scrotal sac.