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Testicular torsion is the twisting of a testis (testicle) on its connection.
The testes are suspended in the scrotum by a single bundle of tissues that also carries the blood supply to and from the testes. If the testicle rotates, the bundle kinks, and the blood supply is shut off. The resulting situation is an emergency because the testis will die within hours if the blood supply is not restored.
Causes and symptoms
Some testes hang in such a way that they twist more easily than others. Nearly all torsions happen to adolescent males—between the ages of 12 and 18—because their testes enlarge by a factor of five to six during puberty. A larger testis is more likely to twist. Torsion can also occur in a newborn.
Symptoms of testicular torsion are sudden severe pain in the scrotum, swelling, nausea and vomiting.
A nuclear scan of the scrotum may be performed. In this procedure, a tiny amount of radioactive fluid is injected into the blood and detected as it flows through the scrotum and testicles. Torsion is indicated if the radioactive fluid does not flow through the sore testis. Ultrasound scan accompanied by a contrast agent can also be used to diagnose testicular torsion.
Surgery must be performed within 24 hours to ensure the health of the affected testis. During the procedure, the surgeon untwists the cord and secures the testis in place so that it cannot rotate again. The other testicle should also be secured to deter future testicular torsion. This procedure is called orchiopexy.
If the torsion is relieved within 24 hours, the testis will recover normal blood flow and function.
Torsion of the unaffected testis is prevented by securing it during the surgery to correct the twisted testis.
Walsh, Patrick C., et al., editors. Campbell's Urology. Philadelphia: W. B. Saunders Co., 1998.
Orchiopexy — The surgical securing of the testis to prevent torsion.
Scrotum — The bag of skin below the penis that contains the testes.
testicular torsionTorsion of testes Urology Twisting of the spermatic cord, with ↓ blood supply to the testes and scrotum; it is the most common cause of scrotal pain in boys, most of whom are < age 6, ±linked to ↓ connective tissue in the scrotum, trauma, or physical activity
A urological emergency in which the testis is starved of its blood supply as it twists on the spermatic cord. The condition causes unilateral scrotal pain, often accompanied by nausea and vomiting, and typically occurs in young boys or adolescents. A characteristic physical finding is loss of the cremasteric reflex on the affected side. Treatment is a prompt operation to relieve the twisting of the cord. A delay in surgery beyond 6 hr rapidly increases the likelihood that the testicle will be lost.
See also: torsion