What Is Testicular Torsion?
common cause of a urologic emergency related to the genitourinary tract is
a highly painful one called testicular torsion.
Men have two testicles that rest inside the scrotum. A cord
known as the spermatic cord carries blood to the testicles. When a man
experiences torsion of testes, this cord twists. As a result, blood flow is
affected and the tissues in the testicle can start to die.
According to the American
Urological Association (AUA), it’s uncommon and affects only about 1 in
4,000 young men. Torsion is most common in adolescent males. However, older men
and infant boys can also be affected.
What Causes Testicular Torsion?
Most men who have testicular torsion are born with a higher
risk for the condition although they may not know it. Normally, the testicles can’t
move freely inside the scrotum. The surrounding tissue is strong and
supportive. Men and boys who experience torsion sometimes have weaker
connective tissue in the scrotum. This is called a “bell clapper” deformity.
If you have a bell clapper deformity, your testicles can
move more freely in the scrotum. This movement increases the risk of the
spermatic cord becoming twisted.
Testicular torsion can also occur after an injury to the
groin. Rapid growth during puberty may also cause the condition.
The condition can occur anytime. Testicular torsion can
occur when a man is sleeping or when he is engaging in physical activity.
Sports injuries can cause torsion of the testes. As a preventive step, a man
can wear a cup for contact sports.
Testicular torsion usually occurs in only one testicle.
Bilateral torsion, when both testes are simultaneously affected, is extremely
Symptoms of Testicular Torsion
Pain and swelling of the scrotal sac are the main symptoms
of testicular torsion. The onset of pain may be quite sudden, and the pain can
be severe. Swelling may be limited to just one side, or it can occur in the
entire scrotum. You may notice that one testicle is higher than the other. Some
men also experience:
- lumps in the scrotal sac
- blood in the semen
There are other potential causes of severe testicular pain, such
as epididymitis, but you should still take these symptoms seriously and seek
Diagnosing Testicular Torsion
Tests can be used to diagnose torsion. These include:
- physical exam
- urine tests, which look for infection
- imaging of the scrotum
During a physical exam, your doctor will check your scrotum
for swelling. They may also pinch the inside of your thigh. Normally this
causes the testicles to contract. However, this reflex may disappear if you
You might also receive an ultrasound of your scrotum. This
shows blood flow to the testicles. If it’s lower than normal, you may be
suffering from torsion.
Treating Testicular Torsion
Torsion of the testes is a medical emergency, but many
adolescent males are hesitant to say they’re hurting or seek treatment right
away. You should never ignore sharp testicular pain.
It’s possible for some men to experience what’s known as
intermittent torsion. This causes a man to have a testicle twist and untwist.
Because the condition is likely to recur, it’s important to seek treatment,
even if the pain becomes sharp and then subsides.
Surgical repair is usually required to treat testicular
torsion. In rare cases, your doctor may be able to untwist the spermatic cord
by hand. This procedure is called “manual detorsion.”
Surgery is performed as quickly as possible to restore blood
flow to the testicles. If blood flow is cut off for more than six hours,
testicular tissue can die. The affected testicle would then need to be removed.
Surgical detorsion is performed under general anesthesia.
You will be asleep and unaware of the procedure. Your doctor will make a small
incision in your scrotum and untwist the cord. Tiny sutures will be used to
keep the testicle in place in the scrotum. This prevents rotation from
occurring again. The surgeon then closes the incision with stitches.
According to the Mayo
Clinic, 95 percent of men treated for testicular torsion within six hours
of the onset of pain don’t ultimately require testicle removal. However, an
estimated 90 percent of men do require surgical removal of the testicle if
treatment is delivered 48 hours or more after the pain starts.
Removal of a testicle, called orchiectomy, can affect
hormone production in infants. It may also affect future fertility by lowering
If your body begins to make anti-sperm antibodies because of
torsion, this can also lower sperm motility (sperm’s ability to move).
You should seek emergency medical attention right away if
you suspect that you or your child are experiencing testicular torsion to avoid
these possible complications. Testicular torsion surgery is highly effective if
the condition is caught early.