A rare condition, testicular torsion occurs when the spermatic cord is twisted and cuts off the blood supply to the testicle. (Illustration by Argosy Inc.)

  Definition

Testicular torsion is the twisting of a testis (testicle) on its connection.

  Description

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.

  Diagnosis

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.

  Treatment

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.

  Prognosis

If the torsion is relieved within 24 hours, the testis will recover normal blood flow and function.

  Prevention

Torsion of the unaffected testis is prevented by securing it during the surgery to correct the twisted testis.

   Key Terms:

Orchiopexy The surgical securing of the testis to prevent torsion. Scrotum The bag of skin below the penis that contains the testes.

   Resources:

Books

• Rajfer, Jacob. "Congenital Anomalies of the Testes and Scrotum." In Campbell's Urology, ed. Patrick C. Walsh, et al. Philadelphia: W. B. Saunders Co., 1998.
• Rozauski, Thomas, et al. "Surgery of the Scrotum and Testis in Children." In Campbell's Urology. ed. Patrick C. Walsh, et al. Philadelphia: W. B. Saunders Co., 1998.
• Walsh, Patrick C., et al., ed. Campbell's Urology. Philadelphia: W. B. Saunders Co., 1998.