Testicular Torsion

Testicular torsion is a twisting of the spermatic cord, which causes a loss of blood supply to the testes and other anatomical parts within the scrotum. This can happen as a result of strenuous exercise, inadequate connective tissue within the scrotum, or trauma to the scrotum. It also can happen for no reason at all. The testes hang from the spermatic cord and are usually attached to the base of the scrotum by a ligament. The ligament comes loose, the testicle springs up, and it and the spermatic cord become twisted.

Testicular torsion happens most frequently within the first year of life and with the onset of puberty.

The child will experience sudden onset of pain in one of the testicles and also may have swelling in that testicle. Nausea and vomiting are common, as are light-headedness or fainting. The parent or child may notice a lump in the scrotum and blood in the semen. The affected testicle (it is more often the right testicle than the left) may be elevated.

Surgical correction usually is needed, and the sooner the better. If surgery is performed within six hours, the testicle usually can be saved. If too much time passes, the testicle may shrink and require removal. This can happen months or weeks after the torsion event. Severe infection also can occur if the normal blood flow was cut off for a long period.

For the surgery, general anesthesia is used to put the child to sleep. An incision is made in the scrotum, and the testicle is carefully uncoiled. An absorbable stitch is put into place to hold it where it belongs. The untwisted testicle also is secured in place because torsion tends to happen on both sides, and this will prevent it from happening at a later date. After surgery, ice packs are applied to relieve the pain and reduce swelling. An athletic supporter or scrotal support may have to be worn for a week after surgery. Normal activities can be resumed after a few weeks.

Pediatric urologic surgeons who treat testicular torsion:

Paul F. Austin, M.D.

Douglas E. Coplen, M.D.

For an appointment with a Washington University pediatric urologic surgeon, call (314) 454-6034.