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Quick reference medical handouts used by Pediatric offices


Testicular Torsion


Torsion of the testicle is the most common pediatric emergency of the genitourinary tract. In this condition, the testicle twists on itself, blocking its blood supply. If the condition is not treated promptly, the testicle can die.

During fetal development, the testicle develops in a baby boy’s abdomen and moves down into the scrotum, dragging its blood supply behind it like a stem on a fruit. The testicle then becomes suspended from spermatic cords within the scrotum. These cords provide a path for sperm manufactured in the testes and also supply blood to the testicles. Testicular torsion occurs when, for unknown reasons, there is an abnormal twisting of the testicle and its spermatic cord occurs so that the supply of blood is cut off.

Testicular torsion is most often seen in boys 12-18 years of age. The peak age is 14 years, although a smaller peak also occurs during the first year of life. Little can be done to prevent testicular torsion and it usually occurs without any apparent cause. Occasionally, it may be the result of strenuous physical activity.

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 - Sudden scrotal pain is the most common symptom. The pain is caused by the cutting off of the blood supply to the testicle. The discomfort is usually on one side, but it can spread and be felt in the groin, abdomen, and flank. The pain can come during activity, such as sports, after minor accidents, or even during sleep. Up to 50% of teen age boys have had a history of prior episodes of intermittent testicular pain, which have spontaneously resolved and they are too embarrassed to admit that they have a painful testicle.
    • the involved testicle is usually swollen, red, painful and tender. welling , red, and tender testicle. It is frequently elevated in comparison to the other side
    • bruising in newborns
    • firmness in newborns
    • redness
    • difficulty in urinating
    • high-lying testicle
  • 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)
  • A scan or sonogram of the testicle may be done before the decision to perform surgery is made. These tests check the blood flow and help confirm the diagnosis.

Surgery is the only treatment (although on rare occasions the testicle can be untwisted by a specialist without surgery). The key point is the length of time that the blood supply has been occluded. The blood supply should be returned to normal within six hours if its normal function is to be preserved. After that time, there is an increased risk of damage (decreased sperm production and fertility) or death of the testicle.

Because of the risk that insufficient blood supply could destroy the testicle, parents should not attempt to treat sudden onset of testicular pain on their own or choose a wait-and-see attitude. They should seek medical help for their son immediately. Besides being extremely painful, prompt treatment of testicular torsion will avoid the development of permanent damage to the testicle. In addition, parents of teenage boys should remind their adolescent about the importance of reporting testicular pain immediately.

If torsion is diagnosed and treated within 5-6 hours, the prognosis is good. The more time that elapses before resolution worsens the prognosis. After 18-24 hours, necrosis usually develops and indicates removal of the affected testicle (orchiectomy).

 

As a reminder, this information should not be relied on as medical advice and is not intended to replace the advice of your child’s pediatrician. Please read our full disclaimer.

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