Testicular torsion – information for teenagers

Introduction

This leaflet, written for teenagers, explains what testicular torsion is, how it is diagnosed and treated and provides information on care needed after you go home. It is designed to provide additional information to that already provided by the nurses and doctors to try to help answer questions you might have as well as what to do and who to contact.

Please tell the ward staff about all of the medicines you use. If you wish to take your medication yourself (self-medicate) during your stay, then ask your nurse. Pharmacists visit the wards regularly and can help with any medicine queries.

What is testicular torsion?

Torsion is a medical term meaning ‘twist’. Testicles is the medical term for what you may refer to as your ‘balls’. 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 complete 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?

Your scrotum (the sack of skin beneath the penis) contains your 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’) making it 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 you 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 feeling or being sick. Pain may come and go but tends not to go away
• Swelling, especially on one side of the scrotum
• Redness
• Abdominal (‘tummy’) pain
• Your 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?

Your scrotum, testicles, abdomen and groin will be examined. Sometimes this examination cannot definitely exclude torsion and where it remains a possibility, you will need an emergency operation because of the potential risk to the testicle if torsion is left untreated.

Other tests, such as blood tests and scans, are not usually required.

How is testicular torsion treated?

If the doctors believe you might have testicular torsion, you will need an emergency operation. You will be asleep for the operation with a general anaesthetic. One of your parents or a carer can be with you when you go off to sleep and will also be with you in the recovery area when you wake up.

A cut (‘incision’) is made in the scrotum, the testicle examined, untwisted and the testicle observed for return of blood supply. To prevent torsion happening again, the testicle will be ‘fixed’ in place with stitches. To prevent testicular torsion on the opposite side, the other testicle will also be fixed in position. The cuts are closed with stitches that dissolve so they do not need to be removed later.

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

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

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 has meant the testicle has died.

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?

Your parent (or carer) will be informed the operation is finished and can come to the recovery area to be with you. Once you are fully awake you will be taken back to a ward.

How long will I stay in hospital?

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

What happens after I go home?

• All stitches used are dissolvable so these do not need to be removed.
• You may have some discomfort for a few days, so we advise you take regular paracetamol for two days and for a few days longer if you need to.
• Wearing supportive ‘brief style’ pants rather than loose fitting boxers for two weeks can increase comfort. You may have been given underwear called a ‘scrotal support’ which are medical grade supportive pants. These can be swapped to normal cotton pants if preferred after a few days.
• You should rest for the first few days at home and take a week off school/college/work.
• You should avoid swimming for seven to 10 days and avoid strenuous activities, for example physical exercise (PE)/ riding a bike, for three to four weeks.
• The wound site should be kept clean and dry. It is fine to take showers after two days, but avoid baths for five days.
• If you feel unwell, have a fever, have increased pain or notice discharge at the wound site, inform your parent/ carer who can then contact your GP/ nurse specialist.
• All boys and men, whether or not they have needed any surgery related to their testicles, should check their testicles every month to ensure they can be found in the scrotum, that they are approximately the same size as each other and that they feel the same. This will be talked about more at your follow‑up appointment.

Chaperoning

During your hospital visits you 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 support you.

Follow up

You will have a follow-up outpatient appointment, usually six months after your operation, to assess the position and size of the testes. If you have any questions or concerns you can contact us on the numbers below.

For further information please contact

Your nurse specialist: telephone 01223 586973 (paediatric surgery/urology)

The ward you were on: