Testicular torsion

Testicular torsion occurs when a testicle rotates, twisting the spermatic cord that brings blood to the scrotum. The reduced blood flow causes sudden and often severe pain and swelling.

Testicular torsion is most common between ages 12 and 18, but it can occur at any age, even before birth.

Testicular torsion usually requires emergency surgery. If treated quickly, the testicle can usually be saved. But when blood flow has been cut off for too long, a testicle might become so badly damaged that it has to be removed.

Signs and symptoms of testicular torsion include:

• Sudden, severe pain in the scrotum — the loose bag of skin under your penis that contains the testicles
• Swelling of the scrotum
• Abdominal pain
• Nausea and vomiting
• A testicle that's positioned higher than normal or at an unusual angle
• Frequent urination
• Fever

Young boys who have testicular torsion typically wake up due to scrotal pain in the middle of the night or early in the morning.

Seek emergency care for sudden or severe testicle pain. Prompt treatment can prevent severe damage or loss of your testicle if you have testicular torsion.

You also need to seek prompt medical help if you've had sudden testicle pain that goes away without treatment. This can occur when a testicle twists and then untwists on its own (intermittent torsion and detorsion). Surgery is frequently needed to prevent the problem from happening again.

Testicular torsion occurs when the testicle rotates on the spermatic cord, which brings blood to the testicle from the abdomen. If the testicle rotates several times, blood flow to it can be entirely blocked, causing damage more quickly.

It's not clear why testicular torsion occurs. Most males who get testicular torsion have an inherited trait that allows the testicle to rotate freely inside the scrotum. This inherited condition often affects both testicles. But not every male with the trait will have testicular torsion.

Testicular torsion often occurs several hours after vigorous activity, after a minor injury to the testicles or while sleeping. Cold temperature or rapid growth of the testicle during puberty also might play a role.

• Age. Testicular torsion is most common between ages 12 and 18.
• Previous testicular torsion. If you've had testicular pain that went away without treatment (intermittent torsion and detorsion), it's likely to occur again. The more frequent the bouts of pain, the higher the risk of testicular damage.
• Family history of testicular torsion. The condition can run in families.

Testicular torsion can cause the following complications:

• Damage to or death of the testicle. When testicular torsion is not treated for several hours, blocked blood flow can cause permanent damage to the testicle. If the testicle is badly damaged, it has to be surgically removed.
• Inability to father children. In some cases, damage or loss of a testicle affects a man's ability to father children.

Having testicles that can rotate in the scrotum is a trait inherited by some males. If you have this trait, the only way to prevent testicular torsion is surgery to attach both testicles to the inside of the scrotum.

Your doctor will ask you questions to verify whether your signs and symptoms are caused by testicular torsion or something else. Doctors often diagnose testicular torsion with a physical exam of the scrotum, testicles, abdomen and groin.

Your doctor might also test your reflexes by lightly rubbing or pinching the inside of your thigh on the affected side. Normally, this causes the testicle to contract. This reflex might not occur if you have testicular torsion.

Sometimes medical tests are necessary to confirm a diagnosis or to help identify another cause for your symptoms. For example:

• Urine test. This test is used to check for infection.
• Scrotal ultrasound. This type of ultrasound is used to check blood flow. Decreased blood flow to the testicle is a sign of testicular torsion. But ultrasound doesn't always detect the reduced blood flow, so the test might not rule out testicular torsion.
• Surgery. Surgery might be necessary to determine whether your symptoms are caused by testicular torsion or another condition.

If you've had pain for several hours and your physical exam suggests testicular torsion, you might be taken directly to surgery without any additional testing. Delaying surgery might result in loss of the testicle.

Surgery is required to correct testicular torsion. In some instances, the doctor might be able to untwist the testicle by pushing on the scrotum (manual detorsion). But you'll still need surgery to prevent torsion from occurring again.

Surgery for testicular torsion is usually done under general anesthesia. During surgery, your doctor will make a small cut in your scrotum, untwist your spermatic cord, if necessary, and stitch one or both testicles to the inside of the scrotum.

The sooner the testicle is untwisted, the greater the chance it can be saved. After six hours from the start of pain, the chances of needing testicle removal are greatly increased. If treatment is delayed more than 12 hours from the start of pain, there is at least a 75 percent chance of needing testicle removal.

Testicular torsion in newborns and infants

Testicular torsion can occur in newborns and infants, though it's rare. The infant's testicle might be hard, swollen or a darker color. Ultrasound might not detect reduced blood flow to the infant's scrotum, so surgery might be needed to confirm testicular torsion.

Treatment for testicular torsion in infants is controversial. If a boy is born with signs and symptoms of testicular torsion, it might be too late for emergency surgery to help and there are risks associated with general anesthesia. But emergency surgery can sometimes save all or part of the testicle and can prevent torsion in the other testicle. Treating testicular torsion in infants might prevent future problems with male hormone production and fertility.

Testicular torsion will likely occur as an emergency, leaving you little time to prepare. You'll probably first be seen in the emergency room or by your family doctor. However, you'll probably then be seen by a doctor who specializes in urinary tract problems and disorders affecting male genitals (urologist).

If you have some advance warning before you see the urologist, here's some information to help you prepare, and what to expect from your doctor.

What you can do

• Write down any symptoms you're experiencing, including any that might seem unrelated to the reason why you're seeking treatment.
• Write down questions to ask your doctor.

Don't hesitate to ask questions during your appointment. Some questions to ask your doctor include:

• Why did this happen?
• Are there other possible causes for my symptoms?
• What happens if I don't have surgery?
• What are the possible complications of surgery?
• Are there any restrictions on activity that I'll need to follow after surgery?
• How long after surgery will I have to wait to be sexually active?
• Will I be able to father children?
• How can I prevent this from happening again?

What to expect from your doctor

Your doctor is likely to ask you a number of questions. Being ready to answer them might give you more time to go over your concerns. You might be asked:

• When did you first begin experiencing symptoms?
• What were you doing when you first started experiencing symptoms?
• Have your symptoms been continuous, or did they go away for a time?
• How severe are your symptoms?
• Does anything seem to improve or worsen your symptoms?
• Has anyone in your family ever had testicular torsion?
• Has this ever happened to you before?