Testicular torsion in teenagers – information for parents/carers

Introduction

This leaflet, written for parents and carers, explains what testicular torsion is, how it is diagnosed and treated, and provides information on how to care for your son at home. It is designed to provide supportive information in addition to that provided by the nurses and doctors; contact numbers are provided at the end of the leaflet should you have queries after going home.

What is testicular torsion?

Torsion is a medical term meaning ‘twist’. Testicular torsion occurs when the cord (called the ‘spermatic cord’) which carries blood to the testicle becomes twisted. The amount of twisting can range from 180 degrees (half a turn) to 720 degrees (2 full turns). The twisting cuts off the blood supply to the testicle which causes pain and swelling. Testicular torsion is therefore a condition which necessitates emergency management.

How did the twist (torsion) come about?

The scrotum (the sack of skin beneath the penis) contains a boy’s testicles (testicles are also referred to as testes which is plural of testis). Each testicle is connected to a spermatic cord (which carries blood to the testicle). In most boys, the testicle is also attached to the bottom and back of the scrotum which makes it hard for them to twist.

In some boys, the testicle is not secured at the base of the scrotum (called ‘bell clapper deformity’) so it is freer to move and, potentially, twist. In many boys, though, there is no apparent cause.

Testicular torsion can happen at any age (including before birth in a few boys) but is most common between the ages of 10 and 25 years. Testicular torsion may occur during exercise or during sleep and may occur after a trauma or injury to the testicle.

There is nothing that a boy did or did not do that resulted in testicular torsion.

What are the symptoms of testicular torsion?

• Pain in the testis/ scrotum – pain is often severe, often comes on suddenly and may be associated with nausea and/or vomiting. Pain may come and go but tends not to go away.
• Swelling, especially on one side of the scrotum.
• Redness.
• Abdominal pain.
• On examination, the testicle may have been sitting higher than usual in the scrotum and may be in a more horizontal position than usual.

How is a testicular torsion diagnosed?

Examination of the scrotum, testicles, abdomen and groin will be performed. Sometimes, this examination cannot definitely exclude torsion and where this remains a possibility, emergency surgery is advised because of the potential risk to the testicle if torsion is left untreated.

Blood tests and ultrasound are not usually required.

How is testicular torsion treated?

Suspected testicular torsion requires emergency surgery. Your child will be asleep for the operation under a general anaesthetic.

A cut (‘incision’) is made in the scrotum, the testicle examined, untwisting performed and the testicle observed for return of blood supply. To prevent recurrence, the testicle will be ‘fixed’ in place with stitches. To prevent testicular torsion on the opposite side, the other testicle is also fixed in position. The incisions are closed with dissolvable stitches.

If a twist is not found, the testicle will be examined for other causes such as:

• Epididymitis – inflammation of the coiled tube (epididymis) at the back of the testicle that stores and carries sperm. Males of any age can get epididymitis.
• Torsion of Hydatid of Morgagni – a piece of tissue which is left over during a baby boy’s development in the womb and which is not needed.

If the testicle has not survived it will be removed and the scrotum wound closed with dissolvable stitches. The testicle on the other side is fixed in position with stitches to prevent future testicular torsion.

To prevent any delay with this emergency operation, the operation takes place at your nearest hospital wherever possible. Your child may have been transferred to Addenbrooke’s Hospital because of their young age (usually under three years) or because they have an underlying condition that means surgery needs to take place in a hospital that has specialist children’s surgeons and anaesthetists.

What are the alternatives to the operation?

Emergency surgery is the only way to prevent the risk of loss of the testicle.

What are the risks and complications?

From the condition:

It may be necessary to remove the affected testicle during surgery (called ‘orchidectomy’) if the damage caused by the twisting is considered to be irreversible and the affected testicle is therefore not viable (dead.)

If your son has needed to have a testicle removed, he should proceed through puberty normally, as the remaining testicle is sufficient for hormone production. Although fertility will not be known at your son’s age, one testicle is also sufficient for fertility so having only one testicle does not tend to cause long-term problems.

From surgery:

Whilst all surgery carries the risk of complications, the majority of boys do not experience any complications as a result of this surgery. Uncommon complications can include:

• infection in the wound which requires treatment
• collection of blood around the testicle (called a ‘haematoma’) which resolves slowly (in very rare cases requires surgical removal)
• loss of the testicle in the future even though it was hoped the testicle had been saved
• long-term scrotal pain

What happens immediately after the operation?

You will be able to be with your child as soon as they begin to wake in the recovery room. You will be provided with a device called a ‘pager’ which will beep when your child is in the recovery area and awake. Once your child is fully awake he will be taken back to the ward.

How long will my child stay in hospital for and can I stay with him?

After monitoring for a few hours, having something to drink and eat and passing urine your son will be able to go home.

How do I look after my child at home?

• All stitches used are dissolvable, so these do not need to be removed.
• Your child may have some discomfort and should be given paracetamol (Calpol) or other pain killers as directed by the nursing/ medical staff.
• Wearing supportive ‘brief style’ pants rather than loose fitting boxers for two weeks can increase comfort. Sometimes, for teenage boys, the surgeons will put on a scrotal support in theatre, which are medical grade supportive pants. These can be swapped to normal cotton pants if preferred after a few days.
• Your child should rest for the first few days at home and take a week off school.
• Your child should avoid swimming for seven to 10 days and avoid strenuous activities (such as physical exercise (PE)/ riding a bike) for three to four weeks.
• The wound site should be kept clean and dry. Showers are fine after two days, but the wound should not be submersed (for example, bathed) in water for five days.
• If your child develops a fever or has increased pain or discharge at the wound site you should contact your GP/ nurse specialist.
• If our son has need to have a testicle removed, it is important that he learns to care for the remaining one by:
  • wearing appropriate protective clothing during contact sports
  • always attending an emergency department should acute scrotal pain occur
  • performing testicular self examination from teenage years onwards

Chaperoning

During your child’s hospital visits he will need to be examined to help diagnose and to plan care. Examination, which may take place before, during and after treatment, is performed by trained members of staff and will always be explained to you beforehand. A chaperone is a separate member of staff who is present during the examination. The role of the chaperone is to provide practical assistance with the examination and to provide support to the child, family member/carer and to the person examining.

Follow up

Your child will have an outpatient appointment to provide follow up, usually six months after discharge to assess the position and size of the testes. This appointment is sent to you in the post. It is important that you contact the clinic if the appointment is not convenient so it can be rearranged.

For further information please contact

Your nurse specialist: 01223 586973 (Paediatric Surgery/Urology)

The ward you were on: _________________________

To change your scheduled follow up appointment: 01223 216410 (clinic 6)