Disease Description (Causes and Symptoms)

Definition and pathophysiology: This is an emergency condition in which the spermatic cord twists, blocking arterial and venous blood flow to the testicle and causing testicular ischemia. The degree of testicular damage is determined by the angle of rotation and the duration of ischemia (generally, within 6 hours is considered the treatment golden window). Congenital factors that increase the risk include bell-clapper deformity (inadequate fixation of the testicle), undescended testicle, and a horizontal testicular position.
Main causes: It may be triggered by strenuous exercise, trauma, or sudden changes in position, but in many cases it occurs without any specific trigger. Previous scrotal surgery or testicular tumors may also be associated.
Main symptoms: Sudden, severe scrotal (testicular) pain, scrotal swelling, elevation or horizontal positioning of the testicle, nausea and vomiting, lower abdominal pain, and, rarely, urinary frequency or fever. The time of pain onset and its progression are important.

Treatment Methods

Urgency: Immediate emergency evaluation and treatment (surgery) are required if testicular torsion is suspected. Even if the diagnosis is not certain, when the possibility of testicular torsion is high, examinations must not be delayed or surgery postponed.
Nonsurgical treatment: Manual detorsion by a specialist may be attempted, but it may be temporary, and subsequent surgical fixation (orchiopexy) is always recommended.
Surgical treatment: Emergency exploratory surgery is performed to assess for infection and necrosis, followed, when possible, by returning the testicle to its normal position and bilateral orchiopexy. If the testicle is irreversibly necrotic, orchiectomy is performed.
Imaging and tests: Color Doppler ultrasonography is useful for assessing blood flow, but surgery must not be delayed because of the examination. A nuclear medicine test (Penile nuclear scan) may also help with diagnosis.
Medication and pain management: Analgesics may be administered for pain control, but diagnosis and treatment must not be delayed.
Lifestyle and follow-up care: After surgery, protect the scrotum, restrict strenuous exercise, care for the wound, and use follow-up ultrasonography to check testicular blood flow, size, and whether atrophy has occurred. To preserve fertility, consult a urologist if necessary and consider options such as sperm storage.

Items/records to prepare:
- Record the time symptoms began (date and exact time) and the course of changes in pain (intensity and pattern)
- Location of the pain (left/right) and whether there have been similar symptoms in the past (whether they are recurrent)
- Medications currently being taken (including anticoagulants) and history of allergies
- History of previous scrotal or testicular surgery (e.g., orchiopexy or hernia surgery) and history of an undescended testicle
- Recent trauma or exercise, and whether fever, nausea, or vomiting is present
- Copies of previous test results (ultrasonography, blood tests, etc.)
Points to check before the visit:
- Write down the exact time symptoms began and bring it with you (it is important for treatment decisions).
- If you have severe pain, visiting the emergency room is recommended (immediate emergency evaluation may be necessary even before an outpatient visit).
Sample questions (checklist the patient can give to the doctor):
- When did the symptoms begin? Is the pain gradually getting worse?
- What activity were you doing immediately before the pain began (exercise, trauma, etc.)?

How will this condition affect my fertility (sperm production and ability to conceive)?
What is the recovery period after surgery (or treatment), and when can I return to daily activities?
What are the possible complications (testicular atrophy, chronic pain, infection, etc.), and how can they be prevented?
Are there situations in which conservative treatment can be chosen instead of surgery? What are the criteria?

My symptoms began X hours ago (for example, 4 hours ago). How likely is it that my testicle can be saved?
Why do you recommend bilateral orchiopexy during surgery? Is it not sufficient to fix only one side?

Summary of References/Precautions:

Scrotal pain may be an emergency, so if sudden severe pain occurs, visit an emergency room or urology department as soon as possible.
Treatment must not be delayed because of imaging tests or analgesics.
The timing of treatment has a decisive effect on the prognosis (testicular salvage rate).