• What is torsion of the testis?

  Torsion of the testicle is the most common pediatric urologic emergency. Torsion means that the testicle (testis) itself has been twisted or torsed. The twisting or torsion blocks the blood vessels, which supply the testicle with oxygen and other nutrients. When torsion has occurred and is unrelieved the testicle can undergo complete necrosis or in simple words death of the testis

• Why does torsion of the testicle occur?

  In the fetus the testicle develops within the abdomen and migrates down into the scrotum, trailing its blood supply behind it like a leash. In the scrotum the testicle resides within a smooth sac or bag called the tunica vaginalis. The testicle can spin and move about within the sac. The testis in effect hangs within tunica like a bell clapper hanging from the top with its blood supply. When the testis is too mobile then it can undergo torsion leading to blockage of blood vessels. As males grow and age the testicle develops connections with the sack making it harder for the testicle to spin or twist. Therefore torsion is usually seen in younger men, adolescents, and children.

• What are symptoms of torsion?

  Sudden scrotal pain is the most common symptom. The pain is usually on one side, but it can spread and be felt in the groin, abdomen, and flank. Some patients may have nausea and vomiting or difficulty urinating. The pain can come during activity, such as sports, or after minor accidents. It can come on at rest or even during sleep. Children, particularly teenage boys, are often reluctant to report testicular or scrotal pain. Hours and sometimes days can pass before they see a physician. The diagnosis of torsion can be difficult to make. Other illnesses can appear like torsion, but because torsion, if left untreated, will lead to the loss of the testicle, any acute scrotal pain is treated as torsion until proven otherwise.

• How is torsion treated?

  When testicles have been torsed they can sustain injury. The key factor is the length of time that the blood supply is occluded. Torsion relieved within six hours or less usually results in no lasting effects, but after six hours there is an increasing risk of damage (decreased sperm production and fertility) or death of the testicle. The only treatment of testicular torsion is immediate detorsion and fixation of the testicle to the scrotal wall. These surgeries are best done by Pediatric urologist surgeons or pediatric surgeons.

  The child is put under general anesthesia and a small incision is made through the scrotum. The first step is to detorse the testis and check if blood supply returns back. We do various kinds of things like warming up the testis, giving 100% oxygen and sometimes even papaverine injection to try to get back to blood supply of testis. If the testicle has already died it is removed. If the testicle is viable, it is untwisted and sewn to the scrotal wall (orchiopexy) to prevent any further twisting. When torsion is found on one side the other testicle is also sewn to the scrotal wall (contralateral orchiopexy) because experience has shown that if one testicle can twist the other one can as well.

See case of testicular torsion here - Case 12