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Testicular Torsion

What is testicular torsion?

Testicular torsion is a twisting of the testicles and the spermatic cord. This cord is the structure extending from the groin to the testicles that contains nerves, ducts, and blood vessels. The torsion causes decreased blood flow to the testicles. This strangles them of oxygen and nutrients. It is a painful problem that usually occurs in boys ages 10 and older. While it generally occurs in adolescent boys, it may also happen during fetal development or shortly after a baby is born.

What causes testicular torsion?

In preadolescent and adolescent boys, torsion occurs primarily from incomplete attachment of the testicles within the scrotum. This permits the testicles to be more movable, allowing them to twist. Testicular torsion detected in the fetus happens when development of the protective sac that surrounds the testicles within the scrotum does not attach to the scrotum internally.

The condition is sometimes seen in fathers, sons, and brothers. So it may be genetic.

What are the symptoms of testicular torsion?

The symptoms of testicular torsion may involve one or both of the testicles.

It can cause the following symptoms in the scrotum:

  • Bruising in newborns

  • Firmness in newborns

  • Pain

  • Redness

  • Swelling

It can also cause the following:

  • High-lying testicles

  • Loss of cremasteric reflex (reflex involved in controlling testicular movement into the pelvic cavity)

  • Nausea and vomiting

The symptoms of a testicular torsion may look like other medical problems. Always talk with your child's healthcare provider for a diagnosis.

How is testicular torsion diagnosed?

Testicular torsion is usually diagnosed with a physical exam and a medical history. Your child’s healthcare provider may also do an ultrasound. This is a noninvasive test that uses sound waves to make pictures of the scrotum and testicles to check blood flow. Some healthcare providers may also send children with typical symptoms straight to the operating room for definitive treatment. It is important to make a prompt diagnosis because prolonged testicular torsion may cause irreversible damage to the testicles. Other diagnostic tests may be included. However, there is no test that can diagnose testicular torsion accurately all of the time.

What is the treatment for testicular torsion?

Testicular torsion usually requires immediate intervention. The severity of the torsion depends on if the testicle(s) 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 6 hours of symptoms.

Most boys who develop testicular torsion will require prompt surgery to correct it. Surgery will help prevent torsion from occurring in the future. In some cases, manipulation by hand to untwist the torsion may be possible.

Medical Reviewers:

  • Adler, Liora C., MD
  • Holloway, Beth Greenblatt, RN, M.Ed.