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 the first year of life and at the beginning of adolescence (puberty), but may happen in older men.
Sudden onset of severe pain in one testicle, with or without a previous predisposing event
The health care provider will examine you. This may show:
Extreme tenderness and swelling in the testicle area
The testicle on the affected side is higher
Doppler ultrasound of the testicle can show blood flow. There will be no blood flow through the area if you have complete torsion. It may be reduced if you have a partial torsion of the testicle.
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 (unaffected) side is usually also anchored as a preventive measure. This is because the unaffected 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 fewer 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.
Elder JS. Disorders and anomalies of the scrotal contents. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 539.
Ban KM, Easter JS. Selected urologic problems. In: Marx JA, Hockberger RS, Walls RM, et al, eds. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 7th ed. Philadelphia, Pa: Mosby Elsevier; 2009:chap 97.
Wampler SM, Llanes M. Common scrotal and testicular problems. Prim Care. 2010;37:613-626.
Barthold JS. Abnormalities of the testes and scrotum and their surgical management.In: Wein AJ, ed. Campbell-Walsh Urology. 10th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 132.
Linda J. Vorvick, MD, Medical Director and Director of Didactic Curriculum, MEDEX Northwest Division of Physician Assistant Studies, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington. Louis S. Liou, MD, PhD, Chief of Urology, Cambridge Health Alliance, Visiting Assistant Professor of Surgery, Harvard Medical School. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.