Testicular torsion in children

The article was professionally consulted with Specialist Doctor II Tran Van Trong - Department of General Surgery - Vinmec International Hospital Da Nang.

Testicular torsion is a condition in which the spermatic cord becomes twisted around its axis, blocking the blood vessels that supply the testicles. Testicular torsion in children is an urgent urological emergency, affecting approximately 1 in 4000 men under 25 years of age and is one of the most common causes of testicular loss in men.

Testicular torsion is a condition in which the testicle rotates on its own, causing a sudden blockage of the spermatic cord, reducing or blocking blood flow to the testicle, causing swelling and pain. If this condition persists, it can lead to necrosis of the testicle and surrounding tissues. Therefore, the patient needs emergency surgery within the first few hours. If left too late, the testicles can be permanently damaged, affect fertility or have to be removed.
Testicular torsion usually occurs when the testicle is not fixed in the scrotum and moves abnormally, especially when the testicle is located in the peritoneal canal. Testicular torsion is self-removable.
There are 3 types of testicular torsion:
Torsion of the whole bundle of spermatic vessels causing necrosis of the testis and epididymis: This type of torsion is mainly encountered; Simple testicular torsion: When there is an abnormality of epididymal fixation and there is a mesentery between the epididymis and the testicle, the testicle may be twisted around the mesentery. This type of torsion is less common; Torsion of the appendix of the epididymis - testicle: This type is also rare and the clinical symptoms are not as severe as the two types above. The disease can usually occur at any age but is most common in adolescents (between 2 and 10 years of age). The prevalence of testicular torsion in children is 25-50% for twins in which the child is the second child. Testicular torsion in children is common in infancy or puberty (10-15 years). Pediatric testicular torsion can occur before, during, and after birth.

Testicular torsion disease in newborns has manifestations such as:
At birth, the testicles were enlarged, painless, solid to palpation, the skin in the scrotum was dark red or pale, lost wrinkles, or one side of the scrotum was hollow due to sperm. Torsion of the testicle may have pre-dissolved (absence of testicle). For newborns and breastfed babies who have not been able to locate the pain themselves, there are signs of crying a lot. Fever may occur several hours after the testicle is torsion. In older children, testicular torsion has acute manifestations:
Sudden, severe pain in one or both scrotum, some children are accompanied by lower abdominal pain, nausea and vomiting. Newborns only have fussiness, abstention, edema and redness of the scrotum. Pain, swelling in the lateral inguinal fold without testicle with pain in the lower abdomen (in patients with undescended testicles). Patients may have fever or no fever, no history of scrotal trauma, no symptoms of dysuria, urinary frequency. If detected at a late stage, the patient may have swelling, pain and redness of the scrotum, do not let the scrotum be touched.

Testicular torsion in children often has severe consequences. The cause is because the blood vessels are blocked, so the testicles are not nourished, which can easily lead to injury. If diagnosed and treated slowly, the testicles can become necrotic to pus or completely atrophy within months. Patients are at high risk of infertility, especially in cases where the spermatic cords on both sides of the testicles are twisted respectively. . Children who have one testicle removed are 50% less likely to have children. Especially when growing up, the fact that only one testicle remains in the scrotum will greatly affect the psychology of the child.
Testicular torsion in children is an emergency, the sooner the testicular torsion must be examined and removed, the higher the chance of preserving the testicles (preferably less than 12 hours from the time of pain, swelling of the scrotum - according to world research). If the torsion is not removed in time, the patient will not only not be able to keep the testicles but also affect the reproductive function in the future.
Currently, there are many means of imaging and functional exploration to detect testicular torsion, but no method is absolute. Testicular torsion is sometimes difficult to distinguish from orchitis and epididymitis, requiring surgical exploration. With the advancement of anesthesia and resuscitation today, exploratory scrotal surgery is a simple and safe surgery.
Surgery to remove the torsion will help restore blood supply to the testicles. In addition, doctors also prevent recurrent testicular torsion by immobilizing the testicle, and preventing torsion of the contralateral spermatic cord by immobilizing the opposite testicle. Particularly for the case of testicular torsion in the newborn, no urgent surgery is required to fix the remaining testicle; This can be delayed for several months. Once the varicocele is surgically removed, the child is still at risk of malnutrition and associated secondary testicular atrophy and should be re-evaluated after 6 months.
To prevent testicular torsion in babies, parents need to check their baby's scrotum regularly. If the scrotum is sometimes empty on only one side, the parents need to take it to the hospital for a timely examination.
As a key area of ​​Vinmec Health system, Pediatrics Department always brings satisfaction to customers and is highly appreciated by industry experts with:
Gathering a team of top doctors and nurses in Pediatrics : consists of leading experts with high professional qualifications (professors, associate professors, doctorates, masters), experienced, worked at major hospitals such as Bach Mai, 108.. Doctors All doctors are well-trained, professional, conscientious, knowledgeable about young psychology. In addition to domestic pediatric specialists, the Department of Pediatrics also has the participation of foreign experts (Japan, Singapore, Australia, USA) who are always pioneers in applying the latest and most effective treatment regimens. . Comprehensive services: In the field of Pediatrics, Vinmec provides a series of continuous medical examination and treatment services from Newborn to Pediatric and Vaccine,... according to international standards to help parents take care of their baby's health from birth to childhood. from birth to adulthood Specialized techniques: Vinmec has successfully deployed many specialized techniques to make the treatment of difficult diseases in Pediatrics more effective: neurosurgery - skull surgery, stem cell transplantation. blood in cancer treatment. Professional care: In addition to understanding children's psychology, Vinmec also pays special attention to the children's play space, helping them to have fun and get used to the hospital's environment, cooperate in treatment, improve the efficiency of medical treatment.