What Is Testicular Torsion?

Testicular torsion is when a testicle rotates, twisting the spermatic cord that provides it with blood and oxygen. Unless the injury is repaired within four to six hours, the loss of blood flow can irreparably damage the testicle, causing what is known as an infarcted or dead testicle.

This may require it to be surgical removed. Even if amputation is avoided, delayed treatment of testicular torsion can result in infertility and chronic pain.

This article explains the symptoms and causes of testicular torsion and how this serious medical condition is treated.

Symptoms of Testicular Torsion

A testicle is one of two egg-shaped reproductive organs tasked with producing sperm and the male hormone testosterone. It is housed within a sac-like pouch of skin called the scrotum situated just below the penis.

Each testicle is suspended from the lower abdomen by the spermatic cord, which contains blood vessels and nerves that service the testicle.

Testicular torsion is a relatively rare condition that almost always involves only one testicle. It is rare for bilateral (two-sided) testicular torsion to occur. It can occur while standing, sitting down, or even while asleep.

Symptoms of testicular torsion are almost invariably severe and typically include:

• Sudden and severe pain in one testicle
• Sudden swelling of the testicle (making it look larger than the other testicle)
• A testicle that is suddenly higher-than-normal or turned at a strange angle
• Sudden redness or darkening of the scrotum
• Severe lower abdominal pain
• Nausea or vomiting
• Frequent urination
• Fever
  

Younger boys with testicular torsion will commonly awaken in the middle of the night or early morning and complain of extreme scrotal pain.

Possible complications of testicular torsion include chronic scrotal pain, infertility, and hypogonadism (low testosterone). The risk of complications increases the longer that emergency treatment is delayed.

Intermittent Testicular Torsion

Some people may experience symptoms of testicular torsion that spontaneously subside. This may be due to a condition known as intermittent testicular torsion in which the rotated testicle will suddenly "untwist."

Even if symptoms resolve, intermittent torsion increases the risk of future, potentially severe episodes and should be attended to as a matter of urgency.

Causes of Testicular Torsion

It is not always clear what causes testicular torsion. With that said, genetics may influence how the testicle and spermatic cord develop and make them more vulnerable to twisting.

Under normal circumstances, it is difficult to rotate the testicle to a degree where the blood supply is cut off. However, some males are born with a condition known as the bell clapper deformity. This is when the testicle hangs freely without the tissue "scaffolding" that limits its movement. A deformity of this sort can predispose a person to testicular torsion.

Other factors linked to an increased risk of testicular torsion include:

• Being between the age of 12 and 18
• Having an undescended testicle
• Having a family history of testicular torsion
• A traumatic injury to a testicle
• Prior testicular injury or surgery
• Rapid growth during puberty
  

It’s possible for a newborn to be born with testicular torsion, although the testicle will likely be irreparably damaged (dead) at birth. Testicular torsion in newborns usually causes no pain.

How Common Is Testicular Torsion?

Testicular torsion is relatively uncommon, affecting one in every 4,000 males under the age of 25.

With that said, it can affect males of all ages, from newborns to seniors. Males ages 12 to 18 account for roughly 65% of cases.

Diagnosis

Testicular torsion is diagnosed with a physical examination of the scrotum and testicles. An imaging device called a Doppler ultrasound can visualize blood flow to the testicle using reflected sound waves. These two procedures are usually enough to render a diagnosis.

In an emergency setting, the treatment will be directed by a healthcare provider specializing in the male reproductive tract, known as a urologist.

Treatment For Testicular Torsion

Testicular torsion is a medical emergency requiring prompt treatment. Long-term damage can occur if treatment is not delivered within four to six hours.

There are two ways that the condition can be repaired:

• Manual detorsion: This is when the healthcare provider grasps the testicle and rotates it within the scrotum in an outward direction one to two 360-degree turns. The procedure can be very painful and would still require surgical treatment afterward to secure the testicle in place with a series of sutures (stitches).
• Orchiopexy: This is a surgery in which an incision is made on the scrotum to temporarily remove the testicle, untwist it, and secure it in place with sutures. Depending on a person's age and other factors, orchiopexy may be performed under regional anesthesia (used to numb the lower body) or general anesthesia (which puts you to sleep).
  

Studies suggest that 75% of males for whom testicular torsion surgery is delayed by 12 hours will require surgical amputation of the dead testicle (known as orchiectomy).