Testicular torsion
Testicular torsion occurs when the spermatic cord (from which the testicle is suspended) twists, cutting off the blood supply to the testicle. The most common symptom in children is sudden, severe testicular pain. The testicle may be higher than usual in the scrotum and vomiting may occur. In newborns, pain is often absent and instead the scrotum may become discolored or the testicle may disappear from its usual place.
| Testicular torsion | |
|---|---|
| 1. Epididymis 2. Head of epididymis 3. Lobules of epididymis 4. Body of epididymis 5. Tail of epididymis 6. Duct of epididymis 7. Deferent duct (ductus deferens or vas deferens) | |
| Specialty | Urology |
| Symptoms | Severe testicular pain, elevated testicle |
| Complications | Infertility |
| Usual onset | Sudden |
| Types | Intravaginal torsion, extravaginal torsion |
| Risk factors | "Bell clapper deformity", testicular tumor, cold temperature |
| Diagnostic method | Based on symptoms |
| Differential diagnosis | Epididymitis, inguinal hernia, torsion of the appendix testicle |
| Treatment | Physically untwisting the testicle, surgery |
| Prognosis | Generally good with rapid treatment |
| Frequency | ~1 in 15,000 per year (under 25 years old) |
Most of those affected have no obvious prior underlying health problems. Testicular tumor or prior trauma may increase risk. Other risk factors include a congenital malformation known as a "bell-clapper deformity" wherein the testis is inadequately attached to the scrotum allowing it to move more freely and thus potentially twist. Cold temperatures may also be a risk factor. The diagnosis should usually be made based on the presenting symptoms, but requires timely diagnosis and treatment to avoid testicular loss. An ultrasound can be useful when the diagnosis is unclear.
Treatment is by physically untwisting the testicle, if possible, followed by surgery. Pain can be treated with opioids. Outcome depends on time to correction. If successfully treated within six hours onset, it is often good. However, if delayed for 12 or more hours the testicle is typically not salvageable. About 40% of people require removal of the testicle.
It is most common just after birth and during puberty. It occurs in about 1 in 4,000 to 1 in 25,000 males under 25 years of age each year. Of children with testicular pain of rapid onset, testicular torsion is the cause of about 10% of cases. Complications may include an inability to have children. The condition was first described in 1840 by Louis Delasiauve.