Testicular Torsion

Testicular torsion, sometimes referred to as torsion of the spermatic cord, is a twisting of the spermatic cord that cuts off the blood supply to the testicle. It's a rare condition that can destroy a testicle in as little as four to six hours.

Each testicle is connected to the internal reproductive organs by the spermatic cord, a structure that contains blood vessels, nerves, muscles, and 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.

If your son is diagnosed with testicular torsion, Boston Children's Hospital pediatric surgeons will immediately step in to alleviate his condition.

• Testicular torsion can occur in both newborns and adolescents.
• It's a rare condition that can destroy a testicle.
• If you suspect that your son has testicular torsion, seek emergency medical assistance immediately.

When a child has testicular torsion, he may have an enlarged, reddened, and tender scrotum (the bag of skin hanging behind the penis). Older boys and young men who develop torsion may have symptoms such as:

• Testicular pain
• Abdominal pain
• Nausea
• Vomiting

Half of the time, boys who have testicular torsion have experienced previous episodes of testicular pain.

In general, testicular torsion accounts for about 40 percent of all cases of acute scrotal pain and swelling. It usually occurs during two time periods — at birth and during puberty — but it can occur at any age. Many boys and men who develop testicular torsion have an anatomic abnormality that causes the spermatic cord to twist more freely.

Newborn torsion, which accounts for 12 percent of all cases of testicular torsion, is usually discovered after the development of an enlarged, swollen, and reddened scrotum. If this happens before birth, most likely the testicle cannot be saved, but a torsion occurring in the weeks after birth can potentially be untwisted if discovered in time.

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 your child's medical history. Your son may also have a scrotal ultrasound exam to help determine whether blood is still flowing to the testicle, since other conditions can mimic testicular torsion.

Testicular torsion is considered a surgical emergency and warrants immediate attention and evaluation. The testicle will first be explored surgically. If your 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 is also fixed into place to prevent torsion on that side. Although the risk of the other testicle undergoing torsion is low, we recommend surgery on both sides since torsion in both testicles is very serious, rendering the boy infertile and interfering with masculination (though sexual activity will still be possible with testosterone supplementation).

Boston Children's Hospital researchers are constantly working on better ways to both diagnose and treat this condition. One recent study on newborn testicular torsion done here demonstrated the potential value of scrotal ultrasounds with Doppler imaging, in order to rule out scrotal hematoma, another condition in which the symptoms mimic those of testicular torsion.