Definition

Testicular torsion is the rotation of a testicle. This rotation twists the spermatic cord that links the testicle to the body. This blocks blood flow to the testicles.

It needs to be treated within 4 to 8 hours so that tissue does not die.

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Causes

The reason why this happens is not clear. It may be due to recent trauma or activity.

Risk Factors

This problem is more common in newborns and in boys who are 12 to 18 years of age.

Other things that may raise the risk are:

  • Other people in the family who have had this problem
  • Having this problem with the opposite testicle

Symptoms

A key sign is sudden, intense pain in the testicle or scrotum. The pain is often felt only on one side. Other problems may be:

  • Nausea
  • Vomiting
  • Swelling, redness, and warmth of the scrotum
  • A change in the position of the testicle

Diagnosis

You will be asked your symptoms and health history. A physical exam will be done. This is often enough to make the diagnosis.

Images may be taken right away to confirm it. This can be done with Doppler ultrasound.

Emergency treatment may need to be started right away before testing. The diagnosis will be confirmed during surgery.

Treatment

This problem needs to be treated within 4 to 8 hours to prevent tissue death. The testicle may be untwisted by hand, but surgery will still be needed.

Surgery will restore blood flow, repair or remove any damaged tissue, and prevent further twisting. It may be done with either:

  • Detorsion with orchiopexy to untwist the spermatic cord and secure each testicle to the wall of the scrotum to stop future twisting
  • Orchiectomy with orchiopexy to remove a badly damaged testicle and secure the other testicle to the wall of the scrotum

Prevention

There are no current methods to prevent this problem.

RESOURCES:

Family Doctor—American Academy of Family Physicians
http://familydoctor.org

Healthy Children—American Academy of Pediatrics
https://www.healthychildren.org

CANADIAN RESOURCES:

Caring for Kids—Canadian Paediatric Society
http://www.caringforkids.cps.ca

The College of Family Physicians of Canada
http://www.cfpc.ca

REFERENCES:

Tekgul S, Dogan HS, et al; European Society for Paediatric Urology and European Association of Urology (ESPU/EAU). Guidelines on paediatric urology. EAU 2017 Mar.

Testicle pain & testicular torsion. Healthy Children—American Academy of Pediatrics website. Available at: https://www.healthychildren.org/English/health-issues/conditions/genitourinary-tract/Pages/Testicular-Torsion.aspx. Accessed September 21, 2020.

Testicular torsion. EBSCO DynaMed website. Available at:https://www.dynamed.com/condition/testicular-torsion-13. Accessed September 21, 2020.

Testicular torsion. Merck Manual Professional Version website. Available at: http://www.merckmanuals.com/professional/genitourinary-disorders/penile-and-scrotal-disorders/testicular-torsion. Accessed September 21, 2020.

Testicular torsion. Urology Care Foundation website. Available at: http://www.urologyhealth.org/urologic-conditions/testicular-torsion. Accessed September 21, 2020.

Last reviewed March 2020 by EBSCO Medical Review Board Kari Kassir, MD  Last Updated: 9/22/2020