Today in the office I saw one tough young man. F days ago he felt like he might have injured his testis while just sitting down in a truck, but since then the pain in his right testis had just kept getting worse and worse. By the time he saw me today his right testis was swollen to about three times normal size, was extremely tender and the entire spermatic cord was firm and indurated.
I immediately had an ultrasound of the testis done, and this showed markedly reduced flow to the R testis, with increased blood flow to the epididymis. It was not diagnostic of a complete torsion, but certainly was very suggestive of torsion. He may have severe epididymitis but needs further assessment for possible torsion. He is at the urologist now having evaluation for possible surgery.
Torsion of the testis is a fairly common urologic emergency. It generally occurs in boys and very young men. Most of the time it is on just one side, and the key to diagnosis is not misdiagnosing torsion as epididymitis. Epididymitis is much more common than torsion, and occurs also in young men. It is usually easy to differentiate, with tenderness and swelling localized to the epididymitis, the organ on the posterior aspect of the testis that the sperm travel through before entering the vas deferens. Epididymitis is often an infection caused by Chlamydia, gonorrhea, or other infectious agents.
Unlike epididymitis which is treated with antibiotics, rest, and anti-inflammatory medications, torsion is a surgical emergency. The usual treatment is to surgically untwist the testis, and to use a suture to fix the testis in place in the scrotum in a procedure called orchiopexy. Usually both testes are fixed in place at the time of the surgery because of an increased risk of torsion of the other side after it occurs on one side.
If you or your child develops severe pain in one testis, it needs emergent evaluation as delay can result in the death of the testis involved.