Torsion of testis or testicular torsion

   It is a condition in which the testicle rotates on the spermatic cord which supplies blood for the testicles. This result in block of blood supply to testicles causing sever pain and swelling. It is common in males of age group under 25.
                                
     In the fetus the testicle develops within the abdomen and migrates down into the scrotum, trailing its blood supply behind it like a leash. In the scrotum the testicle resides within a smooth sack called the tunica vaginalis. The testicle can spin and move about within the sack. As males grow and age the testicle develops connections with the sack making it harder for the testicle to spin or twist. This is why torsion is usually seen in younger men, adolescents, and children.
It can occur during fetal development leading to neonatal torsion or vanishing testis and is one of the main cause for monarchism (single testicle).
It needs emergency treatment to save the testicles. Other wise it can lead to permanent damage to the testicles leading  to necrosis of testis and atrophy of testis. It can lead to sterility

Signs and symptoms of testicular torsion

• Severe sudden pain in the scrotum.
• Swelling of the scrotum.
• Redness of skin of the scrotum.
• Lower abdominal pain.
• Fever.
• Testicle is positioned at an higher level than normal or at an odd angle.

Tests and diagnosis

• Physical examaintion.
• Urine analysis.
• Testicular ultrasound.
• Nuclear scan of the testicles.
• Surgical exploration.

Treatment of testicular torsion

• Manual detorsion of the torsed testis can be attempted. It is difficult since it is very painful and may not be successful.
• Testicular torsion is an medical emergency requiring immediate treatment. It is called orchidopexy. If treated with in 6 hours 100% chance are there for saving the testicle. During surgery the testicle on other side is also anchored as a preventive measure.

Medical Treatment

If your doctor suspects torsion, a urologist will be notified. Depending on your history and physical, you may either be brought to the operating room or you may have imaging done. Occasionally a testicular torsion may be manually detorsed (untwisted by hand) by a physician.

Medications

In the emergency room, the patient with testicular torsion will probably receive a narcotic such as morphine for pain relief.
Surgery
The goal of surgery is to salvage the testicle. If the testicle cannot be salvaged, the testicle is removed (a procedure known as orchiectomy). If the testicle is detorsed successfully, it will be sutured within the scrotum so that it can no longer twist (called orchiopexy). The other testicle will also undergo the same fixation to the scrotum.
Other Therapy
Patients who have a nonviable testicle may return for the insertion of a prosthetic testicle. This will be done only after the urologists feels that healing from the surgery is complete.

Next Steps

After surgery, the patient will learn if the testicle was able to be salvaged.

Follow-up

The surgeon will inform the patient as to when follow-up is needed.

Prevention

The orchiopexy should prevent further episodes of torsion.