Testicular torsion is an abnormal twisting of the spermatic cord due to rotation of a testis or the mesorchium (a fold in the area between the testis and epididymis), which causes strangulation and, if untreated, eventual infarction of the testis. This condition is almost always (90%) unilateral in presentation, but the defect is bilateral, requiring both testicles to be surgically treated. Testicular torsion 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.
Normally, the tunica vaginalis envelops the testis and attaches to the epididymis and spermatic cord. In intravaginal torsion (the most common type of testicular torsion in adolescents), testicular twisting may result from an abnormality of the tunica, in which the testis is abnormally positioned, or from a narrowing of the mesentery support. In extravaginal torsion (most common in neonates), loose attachment of the tunica vaginalis to the scrotal lining causes spermatic cord rotation above the testis. Typically, there’s no history of trauma, and the pain occurs suddenly. A sudden forceful contraction of the cremaster muscle may precipitate this condition. (See Extravaginal torsion.)
Torsion produces excruciating pain in the affected testis or iliac fossa. Nausea, vomiting, and light-headedness may also occur.
Physical examination reveals tense, tender swelling in the scrotum or inguinal canal and hyperemia of the overlying skin. Doppler ultrasonography helps distinguish testicular torsion from strangulated hernia, undescended testes, or epididymitis.
Treatment consists of untwisting the testes and immediate surgical repair by orchiopexy (fixation of a viable testis to the scrotum) or orchiectomy (excision of a nonviable testis). Both testes are usually anchored to the scrotum as a preventive measure. As with ovarian torsion in the female, preservation of the organ is the preferred option. If surgery is performed within 6 hours, most testicles can be saved.
❑ Promote the patient’s comfort before and after surgery.
❑ After surgery, administer pain medication as ordered. Monitor voiding, and apply an ice bag with a cover to reduce edema. Protect the wound from contamination. Otherwise, allow the patient to perform as many normal daily activities as possible.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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More About This Book:
Title: Professional Guide to Diseases (Eighth Edition) Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2005 ISBN: 1-58255-370-X 
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