Torsion arises from a birth defect in which the testicles hang free in the scrotum. If a testis dangles freely, it can twist around on its cord. This twisting is called torsion. It can destroy the testicle. Though torsion is fairly rare, all parents of pubertal boys should be aware of the symptoms.
When the cord twists, the blood vessels inside are squeezed tight. Hot fresh blood still enters as it is pumped in under pressure. But the cooler used blood, which flows more slowly, is trapped and cannot get out. The testicle quickly swells up. No more blood can get in or out. There is pain, usually sudden and severe. There may be nausea and vomiting. The lower abdomen may hurt. “Swelling-with-pain” always requires urgent investigation.
Torsion is a surgical emergency. At detorsion, the testicle is untwisted and stitched firmly in the scrotum. It is a simple 10 minute procedure. The time factor is critical. If the cord is not untwisted four to six hours after the symptoms begin, the testicle starts to atrophy, to wither and die. Slowly yet surely, the life is strangled out of it. Recovery is possible in the next 12 to 24 hours. After this, the chances of life are slim. After 48 hours, an orchidectomy is required to remove the dead testicle.
Torsion is usually unilateral, on one side only. But when one testis has twisted, the other is at risk. At detorsion, both testicles should be stitched in place. Be sure this is done. It used to be thought torsion occurred mainly in newborns. In older boys, the testes become swollen and hurt for many reasons, and the correct diagnosis was often overlooked. New technology helps diagnosis by use of ultrasound and the Doppler stethoscope. If blood is heard swooshing in and out of the testis, the problem is not torsion.
It is now known 65 percent of torsion cases happen between ages 12 and 18. It can also occur in the early 20s. More rarely, at a later age.
A few boys have a history of mild “swelling-with-pain” which remits spontaneously. Parents may think it of no real concern. Beware! Avoid waiting for the pain “to get better by itself.” If the swelling is bilateral and surgery is delayed, the boy cannot mature into manhood – a tragedy beyond words.
Note the swelling-with-pain combination. This is the key for alarm bells to ring. Infections such as mumps can cause the same symptoms. Avoid parental diagnosis. Under age 21, always suspect torsion. Take the boy to the emergency room at once.
It is not unknown for a boy who thinks masturbation evil to believe the symptoms are due to his actions. He then endures the pain until it becomes excruciating, by which time it may be too late. Should a boy be told of the risk of torsion? Will he become anxious? Parents can estimate the degree of information; a sensitive youth need only know to report swelling with pain in the testicles at once.