There aren’t many true emergencies in my field of pediatric urology, but torsion of the testicle is one of the more common ones that I face on a regular basis. Unfortunately, my experience is that most people are unaware of the issue, even though it can happen in 1 in 4,000 males under age 25. Testis torsion can occur at any age, including adults or even before birth, but it is most common in newborns and teenagers.
What Is Testis Torsion?
Torsion, or twisting of the testicle, occurs when the cord structures which attach to the top of the testicle suddenly twist around themselves one or more times. This happens spontaneously and is usually not associated with trauma or external injury to the testicle. Testis torsion is a surgical emergency, because if it is not corrected in time, the testis will need to be removed because of the loss of blood supply.
What Are the Symptoms?
Testis torsion causes severe scrotal pain, which can radiate to the lower abdomen or cause nausea or vomiting.
In newborns, the testis is not well fixed in the scrotum yet and the entire testicle and its surrounding structures can twist. When this happens, it can be very hard to make a diagnosis, since babies cannot communicate their pain. This often leads to delayed diagnosis. In the majority of cases, the testis unfortunately cannot be saved.
Older children and teens are more likely to tell a parent or guardian about their pain or scrotal swelling so that they can receive medical attention. But some teens are embarrassed about discussing the pain with a parent or try to be “tough” about their discomfort, and this delays diagnosis. If the pain has lasted for several days, this can also result in loss of the testicle.
What Is the Treatment?
Testis torsion is a clinical diagnosis. That means that the history of the symptoms and pain, along with physical exam, usually give a doctor enough information to make the diagnosis. If the diagnosis is unclear, though, a scrotal ultrasound can be done to evaluate the testicles and their blood supply. This can help to rule out other causes of scrotal pain that do not require surgery and can be treated with conservative measures, such as rest, ice, scrotal support, and pain and anti-inflammatory medications like Ibuprofen.
If testis torsion is confirmed, then immediate surgery is needed. When this is recognized in enough time and a diagnosis is not delayed, we are able to save the testicle. In all cases, we always tack down the testicle on the opposite side to prevent torsion from happening again.
With proper awareness of testis torsion and immediate timely medical intervention, especially in older children and teenagers, treatment is possible and we can prevent future occurrences. Boys should pay attention to any changes in the size, color or appearance of their scrotum. If they notice these changes and have sudden severe scrotal pain or swelling, they should immediately let a parent or guardian know so appropriate medical attention can be sought.
Seth Alpert, MD is an attending surgeon in the Section of Urology at Nationwide Children’s Hospital and Clinical Associate Professor of Urology at The Ohio State University Medical Center.
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