Testicular torsion is the twisting of the spermatic cord, which cuts off the blood supply to the testicle and surrounding structures within the scrotum.
Torsion of the testis; Testicular ischemia; Testicular twisting
Causes, incidence, and risk factors
Some men may be predisposed to testicular torsion as a result of inadequate connective tissue within the scrotum. However, the condition can result from trauma to the scrotum, particularly if significant swelling occurs. It may also occur after strenuous exercise or may not have an obvious cause.
The condition is more common during infancy (first year of life) and at the beginning of adolescence (puberty).
Sudden onset of severe pain in one testicle, with or without a previous predisposing event
The doctor will perform a physical exam. This usually shows extreme tenderness and swelling in the testicle area. It is more common on the right side. The testicle on the affected side is higher.
Doppler ultrasound of the testicle can show blood flow. Blood flow will be absent if you have torsion. Most emergency rooms will have this test readily available.
Surgery is usually required and should be performed as soon as possible after symptoms begin. If surgery is performed within 6 hours, most testicles can be saved.
During surgery, the testicle on the other (non-affected) side is usually also anchored as a preventive measure. This is because the non-affected testicle is at risk of testicular torsion in the future.
If the condition is diagnosed quickly and immediately corrected, the testicle may continue to function properly. After 6 hours of torsion (impaired blood flow), the likelihood that the testicle will need to be removed increases. However, even with less than 6 hours of torsion, the testicle may lose its ability to function.
If the blood supply is cut off to the testicle for a prolonged period of time, it may atrophy (shrink) and need to be surgically removed. Atrophy of the testicle may occur days-to-months after the torsion has been corrected. Severe infection of the testicle and scrotum is also possible if the blood flow is restricted for a prolonged period.
Calling your health care provider
Go to the emergency room or call the local emergency number (such as 911) if testicular torsion symptoms occur.
Use precautions to avoid trauma to the scrotum. Many cases are not preventable.
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Wampler SM, Llanes M. Common scrotal and testicular problems. Prim Care. 2010 Sep;37(3):613-26, x.
Schneck FX, Bellinger MF. Abnormalities of the testes and scrotum and their surgical management. In: Wein AJ, ed. Campbell-Walsh Urology. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 127.
Linda J. Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington, School of Medicine. Scott Miller, MD, Urologist in private practice in Atlanta, Georgia. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.