Testicular torsion: A terrified urologic emergency

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Several cases of patients who faced the testicular torsion-suspected were referred to my office. The presentation of the symptom will commonly show the pain of the testicular. This topic we will discuss about the truth of the emergency urologic condition – testicular torsion.

Not too much data on the testicular torsion incidence! It is considering that 1 among 4000 men who more likely younger than 25 years old experienced the testicular torsion annually. And it is rapidly to decreasing among aging. The mechanism of the torsion begins from the hyperactive of cremasteric reflex, the natural phenomenon when men experienced a cold environment and its scrotum become elevated up into the groin region. Normally this reflex releasing itself, but unfortunately it is happening when the reflex doesn’t disappear and become twisted, as sudden results it is prolonging and losing blood supply to the testicle. Remains the patients with this incident too long and the risk of testicular lost were reported.

So many literatures trying to find predisposing factors of testicular torsion and it being shown as below:

1. Adolescent
   • All evidence confirmed that Pre-puberty age has the most reported
   • The rapid testosterone hormonal production within this age might induce too strong to the cremasteric reflex.

2. Bell clapper deformity
   • Congenital condition which makes testicle easily twists
   • 12% of normal population were reported to having this deformity condition
3. Cold weather
   • A gigantic report from Brazil showing testicular torsion more likely happens in the winter and also decreasing in humidity
   • The colder weather, the more cremasteric reflex happens

4. Family history of testicular torsion
   • Confirmed data on familial-related are reported
   • Mostly on both testicular torsion at once event

The most common presentation of the symptom for testicular torsion is always single-side all sudden severe testicular pain without improving by any posture or any pain killer. The pain is so hard to describe and it makes patients couldn’t do anything and asked for someone to bringing them to the emergency unit. Once they meet urologist, a full medical history along with physical examination and proper imaging to confirm “No blood supply” on the affected testis will be taken.

The emergency surgical exploration of the scrotal sac must be done within 8 hours to releasing the twists testicle part before they are losing them.  More than releasing of the blood supply, urologist must fix the testes and the scrotal walls to prevent the re-twist in the coming future. If you have any questions, please discuss with your trusted urologist or would be honor if you text me.