Taiwanese teen loses testicle due to overlooked torsion: a urology emergency
A 14 year old Taiwanese student was suddenly afflicted with severe pain and swelling in his left testicle, which began to turn black. After enduring three days of discomfort, the boy sought medical attention.
Renowned urologist, Huang Wei-lun, described his surprise upon examining the boy. His left testicle was not only swollen and hard like an egg but had also taken on a dark hue, sitting higher than the right one. An ultrasound confirmed the doctor’s fears: the testicle had twisted, and the spermatic cord, which carries blood to the testicle, had wrapped around itself multiple times, cutting off the blood supply. The affected tissue had died and turned black, resembling a finger constricted by a rubber band. Despite efforts to untwist the cord, the situation was beyond repair, necessitating an immediate operation.
Huang Wei-lun explained that the patient underwent surgery to remove the left testicle and fixate the right one to prevent future torsion. He has since recovered well without any further complications. Despite only having one testicle remaining, the boy can still produce sperm as normal.
The urologist warned that testicular torsion is an emergency in the urological system, often signified by sudden, severe testicular pain. It is caused by the twisting of the spermatic cord, blocking blood circulation. If not promptly addressed, it can lead to testicular necrosis. The primary cause is usually structural abnormalities present from birth, such as an abnormal testicular sheath allowing the testicle to hang horizontally like a bell clapper, a narrow joining point between the spermatic cord and the testicle, injuries, and undescended testes.
Huang Wei-lun stated that the patient had no history of injury or undescended testes, suggesting a congenital abnormality. He added that adolescents are more prone to this condition due to rapid testicular growth and forceful testicular muscle contractions.
Huang Wei-lun explained that testicular torsion requires emergency surgery. If treated within six hours, there is a more than 90% chance of saving the testicle. However, as time passes, the likelihood of the testicle becoming necrotic increases.
Additionally, Huang Wei-lun warned that testicular torsion often comes with swelling and a higher position of the testicle. Other causes of testicular pain could be related to inflammation of the epididymis, incarcerated hernia, testicular tumours, testicular injury, and even urinary stones, reported Khao Sod. These conditions typically cannot heal on their own and could lead to severe complications if not timely treated.
