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Testicular Torsion

(Torsion of the Spermatic Cord)

Definition

Testicular torsion is the rotation of a testicle. This rotation twists the cord, called the spermatic cord, which connects the testicle to the body. Blood vessels and nerves that are important to the testicles travel through this cord. A twisted cord can block the flow of blood to the testicle and damage the nerves. Without blood flow, the testicle tissue will begin to die. The nerve injury will cause pain.

Testicular torsion is a medical emergency that needs immediate treatment. Treatment should be started within 4-6 hours of the start of symptoms. Delayed treatment can lead to loss of the testicle.

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Causes    TOP

The testicles are normally kept stable by small sections of tissue that lightly connect the testicle to nearby areas. If the tissue is missing, torn, or placed too high, the testicle can turn too much. When the testicle turns, the cord becomes twisted.

Tissues that stabilize the testicles may be damaged by:

  • Bell clapper deformity—A birth defect that is the most common cause of testicular torsion in which the testicular connections do not develop well.
  • Trauma—It may damage connections and/or cause abnormal movement of the testicle.

In some cases, the exact cause may be unknown.

Risk Factors    TOP

Testicular torsion is most common in adolescent boys after puberty. Generally, the risk decreases after age 25.

Factors that may increase the chance of testicular torsion include:

  • Family history of testicular torsion
  • History of testicular abnormalities, such as an undescended testicle or a testicle with irregular orientation in the scrotum

Symptoms    TOP

A hallmark symptom of testicular torsion is sudden, intense pain in the testicle or scrotum. Most often the pain will be on one side, but it can occur on both sides. Other symptoms that may be present include:

  • Nausea
  • Vomiting
  • Abdominal pain
  • Swelling, redness, and/or warmth of the scrotum

Symptoms may appear during exercise, rest, or sleep.

In some cases, symptoms may suddenly stop without treatment. It is still important to see a medical professional to prevent it from happening again and to look for any permanent damage.

Diagnosis    TOP

The doctor will ask about your symptoms and medical history. A physical exam will be done. Testicular torsion may be diagnosed during a physical exam.

If the diagnosis is unclear the following tests may be done for other conditions that cause similar symptoms:

  • Urine test—to look for urinary tract infections
  • X-ray—to examine structures

Blood flow may be assessed with:

Emergency treatment may need to be started right away, without testing. The diagnosis will be confirmed during surgery.

Treatment    TOP

Early treatment can help prevent complications. Testicular torsion is treated with emergency surgery. If surgery cannot be done right away, the doctor may attempt to untwist the spermatic cord by hand.

The goal of surgery is to restore blood flow, repair or remove any damaged tissue, and prevent further twisting. Surgical procedures include ONE of the following:

  • Detorsion with orchiopexy—Untwisting the spermatic cord to restore blood flow. Each testicle is secured to the wall of the scrotum to prevent future twisting.
  • Orchiectomy with orchiopexy—Removal of the affected testicle if there is too much damage. The remaining testicle will be secured to the wall of the scrotum.

Prevention    TOP

There are no current guidelines to prevent testicular torsion.

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:

Sharp VJ, Kieran K, et al. Testicular torsion: diagnosis, management, and evaluation. Am Fam Physician. 2013;88(12):835-840.
Testicle pain & testicular torsion. American Academy of Pediatrics Healthy Children website. Available at: https://www.healthychildren.org/English/health-issues/conditions/genitourinary-tract/Pages/Testicular-Torsion.aspx. Updated August 20, 2015. Accessed October 20, 2015.
Testicular torsion. EBSCO DynaMed website. Available at:
...(Click grey area to select URL)
Updated July 28, 2015. Accessed October 20, 2015.
Testicular torsion. Merck Manual Professional Version website. Available at:
...(Click grey area to select URL)
Updated May 2015. Accessed October 20, 2015.
Testicular torsion. Urology Care Foundation website. Available at:
...(Click grey area to select URL)
Accessed October 20, 2015.
Last reviewed June 2016 by James Cornell, MD
Last Last updated: 6/14/2016

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This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

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