Pediatric Testicular Torsion – All You Need To Know

Did you observe any swelling around your newborn’s scrotum recently? Does your adolescent son complain of severe pain in the scrotum, and does he also suffer from nausea and vomiting? Chances are, that he may be suffering from testicular torsion. Fret not! Read our post and learn all about testicular torsion in children, including the causes, symptoms, and treatment.

What Is Testicular Torsion?

Testicular torsion refers to the torsion or twisting of a person’s testicles and the spermatic cord structure. As a result, blood supply to the testicles and the nearby scrotum is cut off. This is a urological emergency, and it needs immediate medical intervention to prevent gangrene in the testis.

• Although the problem is common among adolescents and neonates, it can affect men of any age and sometimes even before birth.

• Testicular torsion accounts for around 26% of cases of acute scrotum pain – a condition where the patient complains of extreme pain and swelling in the scrotum.

• It is also the main cause for loss of testicles among men.

• Testicular torsion is also responsible for testicular malignancy. One study found a 64% correlation between testicular torsion and testicular malignancy.

Causes Of Testicular Torsion In Children:

Depending upon the age of the patient, testicular torsion can occur due to several factors. Among adolescents, the increased weight of the testicles and sudden contraction of the cremasteric muscles results in testicular torsion. Among neonates, it manifests as extravaginal torsion, i.e. the baby’s testis, epididymis, and tunica vaginalis twist. As a result, the scrotum swells and degenerates. Other causes and types (of the problem) include:

1. Intravaginal Torsion:

The problem is common among children (especially adolescents) with the bell-clapper deformity. When the membrane forming the external covering of the testis and epididymis (also called tunica vaginalis) is high, the spermatic cord rotates, leading to the bell-clamper deformity.

[ Read: Hydronephrosis In Children ]

2. Extravaginal Torsion:

As we mentioned above, extravaginal torsion is common among neonates. When the tunica vaginalis is not secured to the gubernaculum, the spermatic cord twists.

The sudden growth of the testicles, a minor injury to the testicles, vigorous activity, and cold temperature are some of the causes leading to testicular torsion.

Symptoms Of Testicular Torsion:

Some of the common testicular torsion symptoms in children include:

1. Severe pain in one testicle (for no apparent reason)

2. Swelling of the scrotum (usually on one side)

3. Nausea and vomiting

4. Dizziness

5. Blood in the semen

6. Lump in the testicles

Sometimes patients in the pubertal or prepubertal stage may be embarrassed to report scrotal pain. And sometimes, they may confuse scrotal pain with lower abdominal pain. For this reason, all children complaining of lower abdominal pain should be physically examined to rule out testicular torsion. Similarly, the problem is better diagnosed through ultrasonography and Doppler scans, but the diagnosis should not delay treatment.

[ Read: Urinary Tract Infection In Children ]

Treating Testicular Torsion In Children:

Ideally, immediate surgical intervention is suggested for patients. The doctor may also prescribe an analgesic to manage pain because testicular torsion can be extremely painful. Surgery helps to save the patient’s testicle. Some of the highlights regarding treatment include:

1. Surgery within 6 hours of the symptom can save the testicle. During surgery, doctors secure the other side of the testicle as well. This is done because the other testicle is also prone to testicular torsion in future.

2. Patients who received delayed treatment may experience fertility issues and may later need orchiectomy- a procedure to remove testicles to stop the body from producing testosterone.

3. Sometimes, manual detorsion (untwisting) is attempted. But it is rarely successful, because of the fact that patients suffer acute pain during the treatment. And in any case, surgical intervention is the definitive treatment and cannot be substituted for manual detorsion.

4. Even when manual detorsion is successful, the patient is required to undergo surgical treatment before leaving the hospital, the only difference being that surgery is done on an urgent basis and not as an emergency.

5. Patients who are operated upon within 6 hours have only a 5% chance of orchiectomy. The risk increases to about 90% among patients operated after 48 hours of the symptom.²

6. During the surgery, doctors administer general anesthesia before making a small incision in the scrotum to untwist the spermatic cord. The doctor may also fix the other scrotum to prevent subsequent twisting. He may also simultaneously evaluate the testis for viability.

7. Treatment also varies according to age. For example, surgery for testicular torsion among neonates is controversial. A child born with testicular torsion may be too late for surgical intervention- why risk the child to the effects of anesthesia is the general argument. But given the advancement in pediatric anesthesia, some doctors argue that they can save all or some parts of the testis and even prevent its future occurrence.

8. Children born with a normal testis, but subsequently developing a torsion may need immediate surgery. Adults who’ve been diagnosed with testicular torsion should be immediately operated irrespective of the number of hours since the onset of symptoms.

9. Patients who have a nonviable testis may be suggested testicular prosthesis or implanting an artificial testis. This procedure is done after six months or until the scrotum is completely healed.

[ Read: Vesicoureteral Reflux In Children ]

Risks Associated With Treatment:

Some of the possible outcomes of the treatment include:

• Bleeding

• Infection

• Pain

• Wasting away of the testicle despite untwisting

Postoperative Care:

Further treatment largely depends on the viability of the testis. Irrespective of the test results, doctors prescribe pain and swelling relief medications. The doctor may also recommend ice sponging- i.e. ice may be wrapped in a towel and applied to the affected area. He may also suggest bed rest and ask patients to wear a scrotal support for a few weeks. Patients are asked to avoid strenuous activities for about one or two weeks. Among older patients, the doctor may advice resuming sexual activities only after six weeks.

Preventing Pediatric Testicular Torsion:

There’s little that can be done to prevent testicular torsion because this is often an inherited problem. If a parent has testicular torsion, the only way to prevent would be to attach both testicles to the inside of the scrotum.

Did your child suffer from pediatric testicular torsion? How did the doctors diagnose and treat it? Do you have any special tips? Tell us about it here. Leave a comment below.

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