Diagnosing Disorders of the Testicles

¶ … pathophysiology: Testicular torsion

"Testicular torsion occurs when a testicle rotates, twisting the spermatic cord that brings blood to the scrotum. The reduced blood flow causes sudden and often severe pain and swelling. Testicular torsion is most common between ages 12 and 16, but it can occur at any age, even before birth" (Testicular torsion, 2014, Mayo Clinic). Visually, it presents itself as a testicle which is positioned unusually higher than the opposite testicle. The condition can be extremely dangerous. "If the testicle rotates several times, blood flow to it can be entirely blocked, causing damage more quickly" (Testicular torsion, 2014, Mayo Clinic). Some males have testicles which are more prone to rotation, causing a greater likelihood of manifesting torsion. Rapid growth of the testes during puberty is a contributing factor, however, and thus the condition may be present even in young males without the genetic tendency for increased rotation of the testes.

Due to the loss of the cremasteric reflex, the most likely diagnosis for the young man is testicular torsion. "All prepubertal and young adult males with acute scrotal pain should be considered to have testicular torsion until proven otherwise. The finding of an ipsilateral absent cremasteric reflex is the most accurate sign of testicular torsion. Torsion of the appendix testis is more common in children than testicular torsion and may be diagnosed by the 'blue dot sign'" (i.e., tender nodule with blue discoloration on the upper pole of the testis)" (Ringdahl & Teague 2014). Torsion is rarely caused by trauma and is most common in adolescent males whose testes have increased in volume rapidly (such as due to puberty). "Torsion initially obstructs venous return. Subsequent equalization of venous and arterial pressures compromises arterial flow, resulting in testicular ischemia" (Ringdahl & Teague 2014). Mild nausea and fever often accompanies the condition (Testicular torsion, 2014, Mayo Clinic).

A urine test (for infection) and scrotal ultrasound may be used to confirm the condition (Testicular torsion, 2014, Mayo Clinic). Restoration of blood flow should be prioritized. "Once the diagnosis of testicular torsion is confirmed, the rapid restoration of blood flow to the testis is critical. Manual detorsion can provide quick and noninvasive treatment. The physician stands at the supine patient's feet and rotates the affected testicle away from the midline, as though opening a book" (Ringdahl & Teague 2014). However, this is only the first phase of treatment. The efficacy of manual detorsion has a mixed record, with some studies estimating as little as a 26.5% success rate although others cite as high as an 80% rate (Ringdahl & Teague 2014).