Week 3: Acute Illness Presentation – Testicular Torsion
By: Travis Ang, Soseh Babayan, & Bernadette Ashley Villena
Twisting of the testicles around the spermatic cord
Impaired blood supply
Permanent ischemia or damage to the testicular tissue
Urological emergency → timely intervention is essential as ischemia depends on the time frame of the torsion and the extent of twisting
(Laher et al., 2020)
Can occur at any age, yet most common in:
Adolescence → 12-18 years old
Peak → 13-14 years old
Incidence in males under 25 years old
1 in 4000
(Laher et al., 2020)
Under 25 years old
Increased risk if relative had prior history
Sports injury or trauma
Torsion can happen at any instant, even when asleep
(American Academy of Pediatrics, 2023)
Signs and Symptoms
Pain, pain, pain! (unbearable pain in the scrotum with a sudden start)
Scrotum swelling with no particular reason like trauma
Nausea and vomiting
Uneven testicles, one high riding testicle
(Mayo Foundation for Medical Education and Research, 2022)
Anatomy and Physiology
Testes-male sex organs responsible for the creation of sperm and testosterone secretion
Scrotum-sac that holds the epididymis, testes, distal parts of the spermatic cord
A sudden twist of the testes around the spermatic cord due to the testes not being attached well
The testes are being “put in the a choke hold” cutting all blood supply to the testicles causing the spontaneous pain, swelling and the unbalance
(Urology Care Foundation, 2022)
Power doppler ultrasound- most sensitive at detecting flow in and out of the testicle
Color doppler ultrasound- can show the speed and direction of blood flow with colors
Urinalysis-can detect WBC to determine if cause was from infection
(Advanced Radiology Consultant, 2021)
Surgery is required to correct testicular torsion
The sooner the testicle is untwisted, the greater the chance it can be saved.
After 6 hours from the start of pain, the chances of needing testicular removal are greatly increased.
In some cases, manual detorsion can be attempted
Surgery is done under general anesthesia, surgeon will make a small incision in the scrotum, untwist the spermatic cord, and stitch one or both testicles inside the scrotum.
Testicular Torsion in newborns and infants
Very rare, but can occur
(Schick & Sternard, 2022)
Epididmyitis (N45.1)-Erythema, Swelling and pain
Orchitis (N45)-Swelling in one or both testicles, pain, fever
Testis tumor (C62.90)-Pain, discomfort, swelling
Symptomatic hydrocele (N43)-Swollen testicle or testicular discomfort
Scrotal hematoma (S30.22XA)-swelling, pain, and bruising of the scrotum
(Schick & Sternard, 2022)
Needs of the Patient &/or Family
Pain medicine, rest and ice therapy will relieve pain and swelling after surgery
Rest at home for several days
Wear a scrotal support for a week after surgery
Avoid strenuous activities for 1 to 2 weeks,
Resume sexual activity after 4 to 6 weeks.
Educate boys that they can still live a normal life following testicular torsion surgery. The loss of one testicle won’t keep a man from having a normal sexual relations and is still likely to father children when the time is right.
Don’t miss follow-up appointments with your urologist after surgery.
(Mount Sinai, 2021)
Advanced Radiology Consultants. (2021). Color and power doppler ultrasound. Retrieved March 14, 2023, from https://www.adrad.com/ultrasound/color-power-doppler-ultrasound/#:~:text=Color%20Doppler%20converts%20the%20blood,the%20direction%20of%20blood%20flow.
American Academy of Pediatrics. (2023). Testicle pain & testicular torsion. https://www.healthychildren.org/English/health-issues/conditions/genitourinary-tract/Pages/Testicular-Torsion.aspx
Mayo Foundation for Medical Education and Research. (2022, February 24). Testicular torsion. Mayo Clinic. Retrieved March 14, 2023, from https://www.mayoclinic.org/diseases-conditions/testicular-torsion/symptoms-causes/syc-20378270
Mayo Clinic. (2022). Testicular Torsion. Retrieved from https://www.mayoclinic.org/diseases-conditions/testicular-torsion/diagnosis-treatment/drc-20378274#:~:text=Surgery%20is%20required%20to%20correct,usually%20done%20under%20general%20anesthesia.
Mount Sinai. (2022). Testicular Torsion. Retrieved from https://www.mountsinai.org/health-library/surgery/testicular-torsion-repair#:~:text=You%20may%20wear%20a%20scrotal,about%204%20to%206%20weeks.
Laher, A., Ragavan, S., Mehta, P., & Adam, A. (2020). Testicular torsion in the emergency room: A review of detection and management strategies. Open Access Emergency Medicine, 12, 237-246. https://doi.org/10.2147/OAEM.S236767
Schick, A. M., & Sternard, T. B. (2022). Testicular Torsion. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK448199/#:~:text=Other%20differential%20diagnoses%20to%20be,other%20etiology%2C%20and%20scrotal%20hematoma.
Urology Care Foundation. (2022). Testicular Torsion: Symptoms, Diagnosis & Treatment. Retrieved March 14, 2023, from https://www.urologyhealth.org/urologic-conditions/testicular-torsion
Thank you for viewing 🙂
-Travis, Soseh, & Bernadette