Testicular torsion

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What is testicular torsion?

Testicular torsion happens when one of your testicles twists around.

Each testicle is attached to a spermatic cord, which contains blood vessels that carry blood to the testicle. In testicular torsion, this becomes twisted (called torsion) and blocks the flow of blood to the testicle.

Testicular torsion is an emergency. If the blood supply is cut off for too long, your testicle could become permanently damaged.

Testicular torsion is most common in teenage males, but can occur at any age.

When should I go to the emergency department?

If you or your child has sudden pain in the scrotum or sudden pain in the lower abdomen (tummy area), go to your nearest hospital emergency department immediately. These are signs of testicular torsion, which is an emergency and requires surgery within a few hours..

What are the symptoms of testicular torsion?

Symptoms of testicular torsion include:

sudden, severe pain in your scrotum
swelling and redness of your scrotum
nausea and/or vomiting
pain in your lower abdomen or thigh
your testicle being higher than normal or on an unusual angle
difficulty walking

Sometimes, testicular torsion can cause a sudden pain that goes away without treatment. This happens if your testicle twists and then untwists on its own. If this happens, see a doctor as soon as possible. You may need surgery to prevent it happening again.

What causes testicular torsion?

It is not always clear why a testicle twists. Sometimes it happens after intensive exercise or an injury to the area, but most of the time there is no known cause.

Some people have testicles that are held in place loosely inside their scrotum and can move more easily than for other people. This can lead to testicular torsion.

Testicular torsion is also more likely if:

it runs in your family
you or your child is going through puberty, which is a time when the testicles grow especially fast
you or your child has undescended testicles

Illustration of male anatomy, including normal state of testicle, bell clapper deformity, torsion of testicle and necrosis of testicle. — An inherited trait, where a male’s testicle moves freely inside the scrotum (known as ‘bell clapper deformity’), might cause testicular torsion. If left untreated, the condition can lead to a permanently damaged or dead testicle which must then be removed.

How is testicular torsion diagnosed?

To diagnose testicular torsion, your doctor will need to examine your scrotum. This might feel embarrassing and awkward, but it is very important. You will also be examined by a surgeon.

There is usually no need for any tests. You might have an ultrasound of your scrotum or abdomen if it’s not clear what is causing the pain in your scrotum or abdomen.

How is testicular torsion treated?

Testicular torsion is generally treated with surgery, which is done as soon as possible. For the best chance of preventing permanent damage your testicle, surgery should be done within 6 hours from when the pain started.

During the operation, the surgeon will make a small cut in your scrotum and untwist the spermatic cord. They will then stitch your testicle to the inside of the scrotum to prevent it from twisting again. The surgeon might stitch your other testicle in place too.

You will need to have a general anaesthetic. The operation lasts about half an hour, and most people go home within the next 24 hours. It’s best to wait a few weeks before playing sport.

Can testicular torsion be prevented?

For most people, there is no known way of preventing testicular torsion.

If your child has undescended testicles, they may need an operation to bring their testicles down and fix them in the scrotum. This will prevent problems — including torsion — in the future.