Testicular Torsion Is a Fertility Risk That Requires Treatment ASAP

Only someone who's faced emergency surgery can truly appreciate the sudden, severe pain in the scrotum that accompanies testicular torsion. Like an appendicitis attack, testicular torsion requires immediate medical attention to prevent dire health consequences and relieve terrible physical suffering.

Testicular torsion is quite uncommon, only occurring in about 1 in 4,000 men younger than age 25, the American Urological Association reports. It is most prevalent in adolescent males ages 12 to 18, who account for 65 percent of all cases. If left untreated, testicular torsion can cause damage to or death of a testicle, possibly resulting in infertility.

An unfortunate trait

Each testicle is suspended by a spermatic cord, which supplies blood and nerves and helps moderate testicular temperature. Think of it as your testicles' lifeline. Torsion happens when a testicle rotates several times on the spermatic cord, which becomes twisted and disrupts blood flow to the testicle. It is unclear what exactly causes this rotation, but it often seems to be the result of an unfortunate inherited trait that allows this random testicular movement.

Symptoms are sudden and severe. The sufferer experiences tremendous pain in the affected testicle, which is often accompanied by a sudden high fever, nausea and vomiting. Emergency surgery is required (ideally within six hours) to save the testicle, which may sustain serious damage or die if blood flow is not speedily restored. In the most serious cases, the testicle must be removed, which may compromise the patient's ability to father children.

Other side effects

For someone in the throes of a torsion attack, infertility probably isn't on their mind. That's because swelling of the scrotum and debilitating abdominal pain make securing medical attention and finding relief a priority superseding all other concerns. In other words, it hurts like hell.

In addition to nausea, fever and pain, a frequent urge to urinate compounds the misery. As if that wasn't enough, a testicle that has undergone the trauma of torsion may be resting at an abnormal angle or positioned higher than usual.

Surgical options

Medical intervention is indicated whether torsion symptoms are intermittent or steady. Orchiopexy takes place under a general anesthetic, and surgeons are sometimes able to simply "unwind" the spermatic cord by hand through a small incision, also known as "manual detorsion," as long as damage to the testicle is not too great. Small sutures are added, which hold the testicle in place and prevent a recurrence of rotation.

This procedure can be done on an outpatient basis. An overnight stay is usually not required unless the affected testicle has been removed. Sex and other strenuous activities should be avoided during recovery, which can be managed with aspirin or some other painkiller, and careful daily cleaning of the scrotum using mild soap and warm water until the area has healed.

Possible complications

Surgery for testicular torsion is fairly straightforward but, as with any surgical procedure, complications can arise. Infection is always a threat and should be guarded against with great care. Getting medical aid as quickly as possible is crucial for avoiding a potentially lethal infection such as gangrene, which can set in if a damaged or dead testicle is not treated or removed soon enough.

The chance of saving a testicle after 12 hours is 50 percent; after a full 24 hours, the chance drops to about 10 percent, so do not delay; an atrophied testicle may permanently lose the ability to produce semen. If you're unfortunate enough to lose a testicle, don't lose hope: Your chances of becoming a father may be reduced, but it is still possible for one testicle to produce sufficient quantities of semen.

Don't ignore the signs

There isn't much that can be done to prevent testicular torsion, but you can mitigate the damage by responding immediately to the symptoms. Testicular torsion may be rare, but it's serious enough to put your reproductive health at risk.