Testicular Torsion

Testicular torsion is a medical emergency. If you suspect your child has testicular torsion, he should be taken to the closest emergency room.

What is testicular torsion?

Testicular torsion is a painful problem that may occur in boys. It is a twisting of the testicles and the spermatic cord (the structure extending from the groin to the testes that contains nerves, ducts, and blood vessels). Testicular torsion causes decreased blood flow to the testes, essentially strangling them of oxygen and nutrients. While it generally occurs in adolescent boys, it may also occur during fetal development or shortly after a baby is born. If testicular torsion is confirmed in a child, an emergency surgery is often carried out. The chance of survival for the testicle is best if surgery is completed within six hours of symptom onset.

What causes testicular torsion?

In preadolescent and adolescent boys, torsion occurs primarily from the incomplete attachment of the testes within the scrotum. This permits the testes to be more movable, allowing them to twist. Testicular torsion detected in the fetus results when development of the protective sac that surrounds the testicles within the scrotum does not attach to the scrotum internally. It is not always correlated with trauma to the scrotum and can occur at any time.

What are the symptoms of testicular torsion?

Testicular torsion is a medical emergency. If you suspect your child has testicular torsion, seek medical attention immediately. The symptoms of testicular torsion may involve one or both of the testes. Although each child may experience symptoms differently, the following are the most common symptoms of testicular torsion.

• Scrotal (involving the scrotum) pain or tenderness, swelling, bruising, firmness, redness and/or high-lying testicles.
• Nausea and vomiting.
• Loss of cremasteric reflex, which is the reflex involved in controlling testicular movement into the pelvic cavity that is normally brought on by cold, touch, or exercise.

The symptoms of a testicular torsion may resemble other conditions or medical problems. Always consult your child’s physician for a diagnosis. If testicular torsion is confirmed in a child, an emergency surgery is often carried out. The chance of survival for the testicle is best if surgery is completed within six hours of symptom onset.

In newborns who had testicular torsion in utero, the symptoms can vary from an undescended testes (testes that have not passed down into the scrotal sac), atrophic testes (testes that have shrunk) or non-palpable testes (testes that cannot be felt). These are usually noticed after birth and may appear as a hard and/or discolored region in the scrotum or groin region.

How is testicular torsion diagnosed?

Testicular torsion is usually diagnosed with a physical examination and a complete medical history. It is imperative to make a prompt diagnosis because prolonged testicular torsion may cause irreversible damage or death to the testes. Scrotal ultrasound may also be completed to help identify if there is appropriate blood flow to the testicles. Testicular torsion is a medical emergency. If you suspect your child has testicular torsion, seek medical attention immediately.

What is the treatment for testicular torsion?

Specific treatment for testicular torsion will be determined by the child’s physician based on:

• The child’s age, overall health and medical history.
• The extent of the condition.
• Your child’s tolerance for specific medications, procedures, or therapies.
• Expectations for the course of the condition.

Testicular torsion requires immediate intervention and is a medical emergency. Many cases of testicular torsion will require a surgery to correct the problem. To minimize long-term consequences, surgical intervention should to be done within six hours of symptom onset. Occasionally, a manual manipulation by a trained provider can reverse the torsion without surgery.

If an infant is born with testicular torsion that occurred while in the womb, it will often not be surgically corrected until the child is at least 6 months old.