The Facts About Testicular Torsion

Testicular torsion is always an emergency situation and a profoundly painful condition. It can cause nausea, vomiting, scrotal swelling and tenderness, among other symptoms.

Testicular torsion is a rare but serious condition in which the testicle rotates and spins the spermatic cord. This cord connects the testicle to the abdomen and contains veins, arteries, nerves and the first stage of the ductus deferens, through which sperm travels from the testes. The rotation of this cord cuts off the blood supply to the testicle.

The patient must get immediate medical attention, because if the testicle has no blood supply for six hours or more, salvage rates start to decline. Findings from studies vary, but between six and 12 hours, the chances are 50 percent to 80 percent that patients will lose the testicle, depending on the study cited. Cleveland Clinic and the American Urological Association (AUA) both state 75 percent of cases require testicle removal if torsion is untreated for 12 hours or more. One study states 90 percent of testicles can be salvaged up to eight hours after the onset of symptoms.

No matter the statistics, the message is clear: Early action is vital.

No direct cause of testicular torsion has been established. It most frequently affects teens and young men between the ages of 12 and 18, a group that makes up 65 percent of cases. However, it can happen to anyone of any age who has testicles. It can even occur inside the womb.

It's believed that some men and boys who experience testicular torsion have a genetic anomaly in the connective tissue inside their scrotal sac that allows the testes to spin more readily. When they are treated for testicular torsion, the doctor can add a tiny suture inside the scrotum to ensure the testicle doesn't spin again in the future.

Testicular torsion occurs when the testicle rotates and the twisting cuts off the blood supply to the testicle. This action results in symptoms that are severe and come on fast, including:

• Severe, continuous pain in the testicle
• Nausea
• Vomiting
• Swelling in the scrotum
• Tenderness in the area
• One testicle sitting higher than the other
• Fever

Speedy treatment is of the essence with testicular torsion. If you experience any of these symptoms for more than a short while, see a doctor immediately or you run the risk of losing a testicle.

Anyone who has testicles is at risk of testicular torsion simply because of the design of the testicles. Since they hang from the spermatic cord inside the scrotum, they can twist at any time.

However, testicular torsion is most common in teens and young men, with 65 percent of cases occurring in people between 12 and 18 years old. Having a recent testicular injury is also associated with the condition, as is cold weather, when the testes are more often pulled up closer to the body.

Another risk factor is when men are born with a genetic anomaly called the "bell clapper deformity." Testicles are usually attached to the scrotum, but if you have the bell clapper deformity, they are attached higher up and the testicles can spin freely, making torsion more likely.

Unfortunately, there is no way to prevent testicular torsion. Being aware of any family history of testicular torsion could help prevent the worst outcome in case it does occur, as you likely would understand the need for immediate treatment.

If a boy has an undescended testicle or experiences testicular torsion due to having the bell clapper deformity, the doctor can take steps to prevent future occurrences by performing an orchiopexy while he is treating the patient. This preventive measure anchors the testicle to the lining of the scrotum so it can no longer spin freely.

Testicular torsion is an emergency condition that requires immediate treatment. The consequences of not getting it treated in a timely fashion can include testicle death due to lack of blood flow. If surgery is delayed more than six hours, it's likely the testicle will need to be removed in a procedure called an orchiectomy. If surgery is delayed more than 12 hours, 75 percent of cases result in a testicle being removed, according to Cleveland Clinic and the AUA.

For some men, testicular torsion can cause fertility issues. Losing a testicle, of course, means the man has only one sperm-producing gonad. But even in cases where the testicle is saved, it may atrophy or remain smaller than the other one.

A urologist is usually able to quickly diagnose testicular torsion with a physical exam, a description of the symptoms and a medical history. If a urologist is not immediately available, occasionally, healthcare workers may use an ultrasound test to check for active blood flow to the testicle.

The doctor looks for symptoms such as the following in order to diagnose testicular torsion:

• Swelling or redness in the scrotum
• One testicle sitting higher than the other
• Tenderness in the scrotum
• Nausea

If it isn't already sufficiently clear, testicular torsion is a condition that requires immediate professional attention. In a majority of cases, it cannot typically be fixed without surgery. If you experience a sudden onset of severe testicular pain, pain in the lower abdomen, swelling, redness, tenderness, one testicle sitting higher than the other, or nausea or vomiting, seek immediate medical help.

The consequences of delay frequently include the death of a testicle through lack of blood flow. This results in the dead testicle being removed in a procedure called an orchiectomy and may contribute to future infertility and other complications.

If testicular torsion is suspected, you should immediately get medical help. The doctor examines you and checks for symptoms such as swelling, redness and one testicle sitting higher than the other.

If they diagnose testicular torsion, they may try to manually detorse, or untwist, the spermatic cord, but testicular torsion usually requires surgery. The surgeon makes an incision in your scrotum and attempts to untwist the spermatic cord. If it's too late to save the testicle, they perform an orchiectomy and remove it. They also affix the surviving testicle—called orchiopexy—to the inner wall of the scrotum to prevent future torsion. And if the twisted testicle can be salvaged, the surgeon affixes both testicles to the scrotal wall.

The prognosis or outlook for someone who experiences testicular torsion almost completely depends on how quickly they are treated. If they get treatment within six hours, the odds are good they will be able to keep the testicle, and it will be more or less normal once it has been sutured to the scrotum to prevent future torsion.

However, if the blood flow is obstructed and treatment is delayed for more than six hours, the odds of retaining the testicle drop significantly. Past 12 hours, 75 percent of people require an orchiectomy to remove the affected testicle.

Newborns with testicular torsion will likely lose the testicle.

Can testicular torsion fix itself?

Almost never. Testicular torsion requires emergency surgery almost 100 percent of the time.

A handful of anecdotal stories highlight people who suffered temporary testicular torsion that unspun itself, but the most important factor in saving the testicle for nearly every person is surgical intervention.

What causes a twisted testicle?

There's no clear explanation for why some people get testicular torsion and others don't, apart from a genetic anomaly called the "bell clapper deformity" that allows testes to spin more easily.

What we do know is that two-thirds of the people who are affected by testicular torsion are between 12 and 18 years old. Educating teens and young men about self-exams and the need to seek immediate help if they experience sharp testicular pain that doesn't recede is paramount. You can get testicular torsion at any age, however, and trauma to the testicles is known to trigger it sometimes.

Is testicular torsion life-threatening?

Usually not, if it's treated quickly enough. However, if testicular torsion is left untreated for a long time, it could potentially cause the dead testicle to turn gangrenous, which could be life-threatening. Testicular torsion that's left untreated for too long is also known to cause sepsis in a small percentage of patients. Sepsis is a condition that can cause life-threatening infections of the blood and organs.