Torsion Of The Spermatic Cord: Symptoms And Causes

Testicular torsion is the twisting of the spermatic cord, which supports the testicles in the scrotum. When this happens, the blood supply to the testicle and surrounding tissues is cut off. The testes are the glands that make sperm. They are ovoid in shape and are located in the scrotal bag.

The blood supply to the testicles comes from the spermatic arteries that arrive through the spermatic cord. On the other hand, venous drainage takes place through the spermatic veins that follow the same path, but in the opposite direction.

When testicular torsion occurs, there is an obstruction of the blood vessels, which leads to a lack of blood flow to the testicle that, if prolonged, can lead to loss of the testicle.

Causes of spermatic cord torsion

Male with an alarm sign in the pubis: Torsion of the spermatic cord

Testicular torsion can occur at any age, it can even occur in older men. However, it is more common during puberty or during the neonatal period.

Some men are more prone to torsion of the spermatic cord due to defects in the connective tissue of the scrotum. Although there is not always a clear cause.

This condition can appear after suffering an injury to the scrotum area that causes a lot of inflammation. Although it can also occur after heavy exercise.

In some cases, there is an anatomical predisposition in which the fixation of the testicle is incomplete or does not exist. It may also be because the spermatic cord is longer than normal.

What are the symptoms?

Pain is the main symptom, and it is characterized by being of sudden onset and of great intensity. The pain is localized to the affected testicle, although it can radiate to the groin area. It can even reach the lower abdomen. Other symptoms that can accompany the pain are:

  • Sickness.
  • Vomiting
  • General discomfort.

There are cases in which it can be seen that the testicle is raised and horizontal in the scrotal bag. Generally, the affected testicle is inflamed, with redness and hardening of the scrotal skin.

The intensity of these symptoms depends on the time of evolution. However, on some occasions, the torsion of the spermatic cord resolves spontaneously  and the pain gradually disappears.

Diagnosis of spermatic cord torsion

Diagnosis of testicular cord torsion can be made by taking the patient’s history and physical examination. Ultrasound is the imaging test that confirms the diagnosis, but it is not always necessary.

Ultrasound will show that blood flow to the testicle is decreased relative to the healthy testicle. This diagnostic test is used in patients who have a doubtful clinical or examination.

Treatment

Spermatic cord torsion surgery

This is a surgical emergency and time is of the essence. This is because the more time that passes, the greater the risk of necrosis and loss of the testicle. If carried out within the first 6 hours, most of the testicles can be saved.

When a boy complains of testicular pain that appears suddenly, it is advisable to consult the doctor immediately. Treatment consists of undoing the torsion and subsequent fixation of the affected testicle.

In some cases, when there is not much inflammation and the surgery is not going to be immediate, the twist can be undone manually, but always proceeding with the surgical intervention later.

If the condition is caught early and treated promptly, the testicle can continue to function properly. The chances that the testicle will need to be removed increase if blood flow is reduced for more than 6 hours. However, at times, it may lose its ability to function.

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