What is Testicular Torsion?

Testicular torsion is the twisting of the tube, called the spermatic cord, which leads to the testicle. When this happens, little or no blood is able to flow to that area. This occurs in about one in every 4,000 males. This condition is a surgical emergency. The testicle can survive for only about six to eight hours without any blood flowing to it. After that, the tissues are damaged, and the testicle no longer works.

Testicular torsion can happen at any age. However, it is most common in newborns or boys going through puberty. When testicular torsion happens during the newborn period, there is a very high chance that the testicle has already been severely damaged and may not be saved.

Causes

There are no specific causes of testicular torsion.

The testicles develop inside the belly and drop down into the scrotum around the sixth month of pregnancy. Once the testicle drops into the scrotum, it attaches to the inside. When a testicle does not drop down into the scrotum (undescended testicle), it does not attach correctly, which causes a higher risk of twisting.

When the cord twists, it blocks the blood leaving the testicle, which causes swelling and pain. This can lead to permanent damage to the testicle. Once testicular torsion has occurred on one side, there is a higher chance it can occur on the other side. This can happen anywhere from a few weeks to months later.

Symptoms

Symptoms can vary based on the age of the child.

• In newborns, there is usually no pain, but the affected side of the scrotum becomes swollen, causing it to become red and hard. Parents may notice scrotal swelling during a diaper change, or the doctor will find it during a newborn exam.
• In older children and adults, the most common symptom is a painful and swollen scrotum. Often, they will vomit and have pain in the lower portion of the belly. The testicle may also lie in an abnormal position (for example, lying sideways in the scrotum).

Treatment

Testicular torsion is a surgical emergency. If the twist has been present for more than eight hours, there is only a 60% chance of saving the testicle.

The only treatment for testicular torsion is surgery. During the surgery, the surgeon untwists the spermatic cord to return blood flow to the testicle. They stitch the testicle in place to prevent any twisting in the future. They often stitch the other testicle because there is a chance of the twist happening on the other side. This happens most often within six months of the first side twisting.

When to Seek Help

Newborns with scrotal swelling should see their pediatrician or come to the Emergency Department. There are some common causes of scrotal swelling in babies that do not involve twisting of the spermatic cord.

Older children or adults who develop testicular pain not caused by recent injury should go to the Emergency Department right away. The best chance to save the testicle is within four to six hours of it twisting. We have clinical protocol in place to coordinate and expedite care between the Emergency Department, the Urology service and the Anesthesia team in the operating room. Our goal is to perform surgical repair within four hours of the patient arriving to the hospital. It is important not to eat or drink on the way to the hospital in case surgery is needed right away.

In the Emergency Department, an ultrasound is usually ordered to help see if any blood is flowing to the testicle. If there is no blood flow found, the Urology team will recommend surgery to untwist and secure the testicle.

Prevention

Since there are no specific causes of testicular torsion, you cannot prevent it.

In some instances, children may have intermittent twisting and untwisting of the testicle (known as torsion-detorsion). Preventive surgery to secure the testicles is sometimes offered to prevent full twisting of the spermatic cord that could result in loss of the testicle.

Since there is a high chance of testicular torsion in undescended testicles, a child may have surgery on the testicle to prevent it from ever twisting.

Care Instructions after Surgery

Following surgery, care instructions would include:

• Resume a normal diet.
• Wear supportive undergarments to minimize discomfort.
• Keep the wound clean. It is OK to shower or sponge bathe the area, but avoid soaking the wound (tub bath or swimming) for five days.
• Apply antibiotic ointment to the wound (Neosporin, Polysporin), three to four times a day for one week.
• To control pain:
• Children less than 3 years old – alternate Tylenol and Motrin/Ibuprofen every four hours for two days and then continue as needed.
• Children older than 3 years old may be given a prescription for a narcotic pain medicine.
• Restrict activity for one week, which includes sports, riding toys or bicycles, and contact activities.