Signs and symptoms of rotation in the male genital area

How does testicular rotation occur? What are the symptoms? At what age can it occur and what is the appropriate treatment for it?

Testicular torsion disease
Testicular torsion is a medical emergency that can cause testicular destruction if left untreated within 6 hours. The testicle has a rope or strap to which it hangs (Figure 1). Inside this rope is the testicular artery, which is responsible for supplying blood to the testicle. It is blocked due to its twisting, and if the arterial blood flow to any organ is cut off, that organ will die within a few hours.

Figure 1- Testicular torsion

The most common cause is a congenital disorder in which the testicle does not attach well to the scrotum and rotates around its rope. What can guide us in the diagnosis is that 65% of these patients are boys between 12-18 years old, and most of the rest occur under the age of 30, but testicular torsion can occur at any age. The disease is relatively common, affecting one in 160 boys at puberty with testicular torsion.

There is a term called testicular torsion, in which the testicle twists from time to time and resolves on its own. Such patients also need surgery. Because the testicle is a secret organ of the body, sometimes some patients, especially boys, are embarrassed to express their problem, and when they feel pain, when asked what problem you have, they say that they have a heart attack.

Symptoms of testicular torsion
The most common symptom is sudden, diffuse pain in the testicles that increases with touching the testicles and the testicles are very sensitive to touch.
• As the testicular cord twists, the testicle goes higher.
Because the testicles share a nerve with the gastrointestinal tract, these patients may experience nausea and vomiting.
Many of the symptoms of testicular torsion are common to those of acute testicular infection, but in acute testicular infection, the patient has a fever and the scrotum usually turns red, and in a urine test, signs of a urinary tract infection can be seen.
Testicular torsion is more common in the cold season.

Figure 2 – Types of testicular torsion

Detection of testicular torsion
If your child suddenly has testicular pain or you suddenly have testicular pain, you should immediately go to a center where there is a specialist and the specialist agrees to examine your child or yourself. Going to clinics and boarding clinics is usually a waste of time. Time is very important, it is enough to refer you from one clinic to another clinic or hospital, you will lose golden time; Therefore, you should choose a place for referral where you have a high probability that testicular torsion disease will be diagnosed and treated as soon as possible.

The doctor can usually make a diagnosis by examination. If there is enough time and there is a Doppler ultrasound in the same center, and if the specialist is present in the clinic and hospital and agrees to take an ultrasound of the patient urgently, Doppler ultrasound can show the testicular artery to twist and become blocked. But time should not be wasted and the patient should be operated on urgently so as not to lose his testicles. Sometimes some doctors do the twisting by hand, but it is not clear how successful this is. If 24 hours have passed since the testicle is twisted, the chance of saving the testicle is zero.

Treatment of testicular torsion
Treatment is surgical removal of the torsion. During surgery, if the testicle is already damaged and blackened, it is removed. In any case, the other side of the testicle, which is healthy, must be fixed to the skin of the scrotum during surgery so that it does not twist later.

In summary:
• Every man, especially in adolescence, is suspected of having testicular torsion if he has severe and sudden testicular pain.
Testicular torsion is a medical emergency.
• The patient should be transferred from the beginning to a center where specialists and related facilities are available.
The golden time for treatment is 6 hours, after which the testicles are damaged.
• During surgery, the healthy testicle of the other side should be fixed to the skin of the scrotum.

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