By Dr. Jogesh K. Harjai, MD
SignatureCare Emergency Center

What is Testicular Torsion?

Testicular torsion occurs when the testicle rotates causing twisting of the spermatic cord impairing its own blood supply.

This causes reduced or complete loss of blood flow to the testicle. This impairment of blood flow causes sudden, severe pain and swelling. If not treated emergently, can result in death of the testicle.

Who can this happen to?

Typically, torsion occurs in newborns and adolescents but can occur in males of almost any age.

What causes Testicular Torsion?

In majority of cases the exact cause of torsion is unknown. In some young men, there seems to be laxity of the tissues that surround the testicle. This allows the testicle to twist around in the scrotum and with it, the spermatic cord.

What are the symptoms of Testicular Torsion?

• Sudden, severe pain in one side of the scrotum(most common symptom)
• Swelling of the testicle/scrotum
• Lower abdominal pain
• Nausea and vomiting
• Fever
• Frequency in urination

Symptoms often occur during sporting or physical activities. Occasionally, the pain can start during sleep and awakens you abruptly.

Of note, pain that eases may not be a comforting sign as this could signify a dying testicle.

How is Testicular Torsion diagnosed?

Your doctor will perform a physical exam and may find the testicle to be twisted sideways. The doctor may also elicit a reflex by pinching or rubbing the inside of your thigh. This may be absent in the setting of testicular torsion.

Often, tests may need to be ordered to ultimately make the diagnosis.

• Urine test – to evaluate for infection
• Testicular Ultrasound – to assess blood flow to the testicle
• Surgery – may be necessary to determine if torsion is causing your symptoms

What should you do if you have symptoms of Testicular Torsion?

Testicular torsion is a true medical emergency and you should seek medical attention immediately.

It is not a good idea to wait and see if the symptoms improve. Ideally, treatment rendered in the first 4-8 hours of symptoms can save the testicle. There is increased risk of testicle loss as time progresses, especially after 24 hours where the testicle may not be salvageable.

How is Testicular Torsion repaired?

The sooner the testicle is untwisted, the greater the chance it can be saved. After 6 hours from the start of pain, the chances of needing testicle removal are greatly increased.

Delays beyond 12 hours from pain onset increase rick of testicle removal to 75%.

See also: Bleeding in First Trimester.

To fix the torsion, surgery is necessary. The surgery requires untwisting of the testicle and then stitching the testicle to the surrounding tissue to fix it in position thus preventing torsion from occurring in the future.

In some instances, the testicle can be untwisted manually without surgery. However, surgery is ultimately necessary to fix the testicle in place.

What is a Partial Torsion?

Same males may experience “warning pains” in testicles from time to time. These are sudden pains that lasts for a few minutes at a time.

This occurs when the testicle twists briefly and returns back to its normal position. These symptoms may be an early warning sign of an impending torsion.

If it’s not a Testicular Torsion, what else could it be?

Pain in the testicles can be caused by many conditions.

These include torsion as discussed, but also appendix testis, epididymitis/orchitis, hernia, hydrocele, trauma, sexual abuse, tumor, edema of scrotum (insect bite/dermatitis), cellulitis, and vasculitis.

Most of these are not emergent, but the diagnosis and treatment of testicular torsion is imperative to avoid permanent loss of the testicle.

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Dr. Jogesh K Harjai, MD, is board certified in Emergency Medicine. He received his medical degree from Saint George’s University School Of Medicine and has been in practice for more than 20 years. Dr. Harjai is currently an emergency medicine physician with SignatureCare Emergency Center.