 Testicular Torsion
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Each testicle is connected to the internal reproductive organs by a spermatic cord, a structure that contains blood vessels, nerves and muscles, as well as a tube for carrying semen. If this cord twists, the blood supply to the testicle is pinched off. Without blood, cells in the testicle will die. Testicular torsion, sometimes referred to as torsion of the spermatic cord, is a rare condition that can destroy a testicle in as little as 4 to 6 hours.
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In general, testicular torsion accounts for approximately 40 percent of all cases of acute scrotal pain and swelling., It usually occur during two time periods: at birth, and during puberty, but it can occur at any age. Neonatal (at birth or just prior to birth) torsion accounts for 12 percent of all cases of testicular torsion. Neonatal torsion is usually discovered after the development of an enlarged, swollen and reddened scrotum. In nearly all cases, these testicles cannot be saved.
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Neonatal torsion is nearly always asymptomatic (without symptoms) In contrast to neonatal torsion, torsion at puberty is carries symptoms, including testicular pain, abdominal pain, nausea, and vomiting. If the scrotum is examined by touch when intense pain begins, the affected testicle will feel swollen, red and very tender. Half of the time boys who have testicular torsion have experienced previous episodes of testicular pain.
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Parents who suspect their son has testicular torsion should seek emergency medical assistance immediately. Emergency room personnel usually consult a pediatric urologist who will make a diagnosis based on a physical examination and history provided by the child or family member. A scrotal ultrasound may also be obtained to help determine the presence or absence of blood flow to the testis since other conditions can mimic testicular torsion.
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Testicular torsion is considered a surgical emergency and warrants immediate attention and evaluation. The testicle will first be explored surgically. If the pediatric urologic surgeon determines that the testicle is viable, the cord will be untwisted and the testicle will be fixed into place to prevent twisting from occurring again. If surgery reveals the testicle is not viable, the testicle is removed. During surgery, the unaffected testicle should also be fixed into place to prevent torsion on that side Although the risk of the other testicle undergoing torsion is low, the result of contralateral torsion is catastrophic, rendering the patient infertile and castrate. For this reason, very prompt exploration and contralateral fixation is recommended
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