The Dongkeng Hospital in Dongguan, Guangdong Province, China, recently announced a medical case in which a young man, pseudonym Xiao Li, sought medical care after experiencing continuous pain in his left testicle for two days. After a thorough examination, doctors discovered testicular torsion with necrosis already present, leaving removal surgery the only option.
According to Sing Tao Daily, the hospital revealed that Xiao Li had suddenly developed severe pain in his lower body a while ago. Upon admission, doctors discovered during exploratory surgery that his left testicle had undergone roughly 360 degrees of counterclockwise torsion, causing the testicle and epididymis to turn purplish-black. Although an attempt was made to reposition the testicle, its color did not return to normal — complete ischemic necrosis had occurred. With the family’s consent, doctors performed removal surgery, and to prevent possible torsion of the right testicle in the future, a simultaneous fixation procedure was carried out.
Urological Emergency
Medically, testicular torsion — also known as spermatic cord torsion — is a urological emergency. Its cause is the rotation of the spermatic cord along its longitudinal axis, compressing the artery supplying blood to the testicle and thus cutting off blood flow; this ultimately leads to ischemic necrosis. The disease has two peak incidence periods, during the neonatal and adolescent phases, with the highest incidence among 12- to 18-year-old teens.
Common triggers include sudden onset during sleep or while at rest, as well as strenuous exercise, trauma, cold temperatures, or sudden changes in body position. The condition often arises without clear warning, starts abruptly, and deteriorates rapidly.
Difficult to Speak Out, Causes Delayed Diagnosis
The hospital reminds the public to seek medical attention immediately if related symptoms appear. The main signs include sudden-onset, severe pain in one testicle, with patients often waking from sleep due to pain, which may even radiate to the groin and lower abdomen. The scrotum may swell, turn red, warm, and become extremely tender; the affected testicle may rise and take on a "transverse" position, with pain significantly increasing when the scrotum is elevated.
Additionally, patients may experience nausea, vomiting, abdominal pain, and fever. It is worth noting that the abdominal pain and vomiting brought on by testicular torsion can easily be misdiagnosed as gastroenteritis. Furthermore, during puberty, patients are often too embarrassed to express discomfort in the private area, which greatly increases the chance of delayed diagnosis and treatment.
6-Hour Golden Window for Treatment
The medical community emphasizes that the golden rescue window for testicular torsion is within 6 hours of onset. If surgical repositioning can be performed within 6 hours, the salvage rate for the testicle can be over 90%; this rate drops sharply to about 50% if delayed to 6 to 12 hours; and if more than 24 hours pass, severe ischemia often results in complete necrosis of the testicle, leaving removal as the only option.
Although, after removal of one testicle, the other side usually compensates and male characteristics and normal fertility are not affected, in clinical practice, a simultaneous fixation procedure for the healthy side is often recommended to prevent future risk of torsion.