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|Quick reference medical handouts used
by Pediatric offices
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
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
- 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
- difficulty in
- 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 childs pediatrician.
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