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Testicular Torsion

Testicular torsion at a glance

  • Testicular torsion occurs when the testicle rotates, causing the spermatic cord, which carries blood into the scrotum, to twist around the testicle.
  • Men with testicular torsion will likely experience acute, intense pain and swelling in the scrotum.
  • The exact cause of testicular torsion isn’t known, but risk factors for having it include possessing a gene that increases testicular mobility, performing strenuous activities and groin injury.
  • Emergency surgery is almost always required to save the testicle and the man’s fertility.

What is testicular torsion?

Testicular torsion is a rare condition, most likely to occur in men under 25, when a testicle (in rare cases both) twists around the spermatic cord. This cord is responsible for supplying blood to the scrotum. The blocked blood flow usually causes profuse pain, discomfort and swelling. The condition requires immediate emergency care. Testicular torsion affects about 1 in 4,000 young men in the U.S. each year.

A definite cause of testicular torsion is not known. Strenuous activity or movements can contribute to testicular torsion. An inherited trait in which the testicle rotates and moves within the scrotum may make testicular torsion more likely, although the trait does not mean that testicular torsion will definitely occur.

Testicular torsion is typically diagnosed during a physical exam or when a patient sees a physician because of pain. A urine test or scotral ultrasound may also be performed in order to confirm a diagnosis. Sometimes performing explorative surgery is the only way to confirm the diagnosis of testicular torsion.

Symptoms of testicular torsion

Men with testicular torsion will experience one or all of the following symptoms:

  • Sudden and intense pain in the scrotum
  • A swollen scrotum
  • One testicle that hangs higher than the other
  • Vomiting, nausea and fever.

It’s important to see a doctor as soon as possible upon experiencing any of these symptoms in order to save the testicle and ensure future fertility.

Treatments for testicular torsion

Testicular torsion typically requires emergency surgery, which will save the testicle if performed in time. Sometimes, when the blood flow stops for too long, the surgeon may need to remove the entire testicle. In some instances of minor torsion, a urologist may be able to untwist the spermatic cord from the testicle, also called manual detorsion.

The testicular torsion surgery, performed under general anesthesia, includes an incision in the scrotum so that the surgeon may access and untwist the spermatic cord. The surgeon may stitch the testicles to the side of the scrotum in order to prevent any future testicular torsion.

When testicular torsion occurs in infants, the treatment procedures can be controversial. If a baby boy is born with symptoms of testicular torsion, it may already be too late to save the testicle and treatment would expose an infant to anesthesia and surgical risks. If parents do not opt for surgery, the boy will be infertile later in life.