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Testicular Torsion

What is testicular torsion?

Testicular torsion is a twisting of the testicle and the spermatic cord, the structure extending from the groin to the testes that contains nerves, ducts, and blood vessels. Torsion causes decreased blood flow to the testes, essentially strangling them of oxygen and nutrients. This is a painful problem that usually occurs in boys ages 10 years and older. While testicular torsion generally occurs in adolescent males, it may also occur during fetal development or shortly after a baby is born.

What causes testicular torsion?

In pre-adolescent and adolescent males, torsion occurs primarily from incomplete attachment of the testes within the scrotum. As a result, the testes move and twist. Testicular torsion in a fetus results when development of the protective sac around testicles in the scrotum does not attach internally to the scrotum.

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?

Symptoms may involve one or both testes and affect each child differently. Common symptoms are:

  • loss of cremasteric reflex, which controls testicular movement into the pelvic cavity and is normally elicited by cold, touch, emotional excitement, or exercise
  • nausea and vomiting
  • scrotal symptoms (involving the scrotum) such as pain, swelling, bruising in newborns, firmness in newborns, redness, and high-lying testicles

Symptoms of testicular torsion may also resemble other conditions or medical problems. Always consult your child's doctor for diagnosis.

How is testicular torsion diagnosed?

Diagnosis entails a physical examination and a complete medical history. A prompt diagnosis is imperative because prolonged testicular torsion may cause irreversible damage to the testes. Other diagnostic tests may be done, but there is no test that diagnoses testicular torsion accurately all the time.

What is the treatment for testicular torsion?

We determine specific treatments based on:

  • child's age, overall health, and medical history
  • child's tolerance for specific medications, procedures, or therapies
  • expectations for the course of the condition
  • extent of the condition
  • your opinion or preference

Testicular torsion usually requires immediate intervention. The condition's severity depends on if the testicle is partially or completely twisted. The more twisted the testicle, the more urgent the intervention. To minimize long-term problems, intervention is usually required within four hours of symptoms.  After four hours, the testis may not be alive and require surgical removal.

The majority of boys who develop testicular torsion need prompt surgery to correct the problem. Surgery helps to prevent torsion from occurring in the future. In some cases, manipulation by hand to untwist the torsion may be possible.