What is this Condition?
This condition involves an abnormal twisting of the spermatic cord caused by rotation of a testicle or the mesorchium (a fold in the area
between the testicle and epididymis), which causes strangulation and, if untreated, eventual infarction (tissue death) in the testicle. This twisting almost always occurs only on one side.
Testicular twisting is most common between ages 12 and 18, but it may occur at any age. The prognosis is good with early detection and prompt treatment.
What Causes it?
Normally, the tunica vaginalis (internal pouch) envelops the testicle and attaches to the epididymis and spermatic cord. Testicular twisting may result from an abnormality of the tunica, in which the testicle is abnormally positioned, or from a narrowing of supporting tissues. In newborns, loose attachment of the tunica vaginalis to the scrotal lining may cause spermatic cord rotation above the testicle. A sudden forceful contraction of the cremaster muscle may precipitate this condition.
What are its Symptoms?
Twisting produces excruciating pain in the affected testicle.
How is it Diagnosed?
A physical exam reveals tense, tender swelling in the scrotum or inguinal canal and hyperemia of the overlying skin. Ultrasound helps distinguish testicular twisting from strangulated hernia, undescended testicles, or epididymitis.
How is it Treated?
Treatment consists of immediate surgical repair by orchiopexy (fixation of a viable testicle to the scrotum) or orchiectomy (excision of a nonviable testicle).