Testicular Torsion

What is testicular torsion?

Testicular torsion 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). The torsion causes decreased blood flow to the testes, depriving them of oxygen and nutrients. This is a painful problem that usually occurs in boys 10 years and older. While it generally occurs in adolescent boys, it may also occur during fetal development or shortly after a baby is born.

What causes testicular torsion?

In pre-adolescent and adolescent boys, torsion is thought to occur because of abnormal or incomplete attachment of the testes within the scrotum. This permits the testes to be more movable, allowing them to twist on their blood supply. 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.

The cause of testicular torsion is unknown. However, some cases have been seen in fathers, sons, and brothers, suggesting a genetic component.

What are the symptoms of testicular torsion?

The symptoms of testicular torsion may involve one or both of the testes. The following are the most common symptoms of testicular torsion. However, each child may experience symptoms differently. Symptoms may include:

  • Scrotal (involving the scrotum):
    • Pain
    • Swelling
    • Bruising in newborns
    • Firmness in newborns
    • Redness
    • High-lying testicles
  • Nausea and vomiting
  • Loss of cremasteric reflex (reflex involved in controlling testicular movement into the pelvic cavity, which is normally elicited by cold, touch, emotional excitement, or exercise)

The symptoms of a testicular torsion may resemble other conditions or medical problems. Always consult your child's physician for a diagnosis.

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 to the testes. Diagnostic tests such as scrotal doppler ultrasound examination of blood flow may be very useful in making the correct diagnosis

Treatment for testicular torsion

Specific treatment for testicular torsion will be determined by your child's physician based on:

  • Your 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
  • Your opinion or preference

Testicular torsion usually requires immediate intervention to untwist the spermatic cord and restore blood flow. If the testicle has been deprived of blood flow for too long it may not be able to recover and removal of that testicle may be necessary. Surgery can also help prevent torsion from re-occurring because the operation also involves firmly attaching both testes to the scrotal sac.