Testicular torsion is the twisting of the spermatic cord, which supports the testes in the scrotum. When this occurs, blood supply is cut off to the testicles and nearby tissue in the scrotum.
Torsion of the testis; Testicular ischemia; Testicular twisting
Some men are more prone to this condition because of defects in the connective tissue within the scrotum. The problem may also occur after an injury to the scrotum that results in a lot of swelling, or following heavy exercise. In some cases, there is no clear cause.
The condition is more common during the first year of life and at the beginning of adolescence (puberty). However, it may happen in older men.
- Sudden severe pain in one testicle. The pain may occur without a clear reason.
- Swelling within one side of the scrotum (scrotal swelling).
- Nausea or vomiting.
Additional symptoms that may be associated with this disease:
- Testicle lump
- Blood in the semen
- Testicle pulled to a higher position in scrotum than normal (high riding)
Exams and Tests
The health care provider will examine you. The exam may show:
- Extreme tenderness and swelling in the testicle area.
- The testicle on the affected side is higher.
You may have a Doppler ultrasound of the testicle to check the blood flow. There will be no blood flowing through the area if you have complete torsion. Blood flow may be reduced if the cord is partly twisted.
Most of the time, surgery is needed to correct the problem. Surgery should be done as soon as possible after symptoms begin. If it is performed within 6 hours, most of the testicle can be saved.
During surgery, the testicle on the other side is often secured into place as well. This is because the unaffected testicle is at risk of testicular torsion in the future.
The testicle may continue to function properly if the condition is found early and treated right away. The chances that the testicle will need to be removed increase if blood flow is reduced for more than 6 hours. However, sometimes it may lose its ability to function even if torsion has lasted fewer than 6 hours.
The testicle may shrink if blood supply is cut off for an extended time. It may need to be surgically removed. Shrinkage of the testicle may occur days to months after the torsion has been corrected. Severe infection of the testicle and scrotum is also possible if the blood flow is limited for a long period.
When to Contact a Medical Professional
Get emergency medical attention if you have symptoms of testicular torsion as soon as possible. It is better to go to an emergency room instead of an urgent care in case you need to have surgery right away.
Take steps to avoid injury to the scrotum. Many cases cannot be prevented.
Elder JS. Disorders and anomalies of the scrotal contents. In: Kliegman RM, Stanton BF, St. Geme JW, Schor NF, eds. Nelson Textbook of Pediatrics. 20th ed. Philadelphia, PA: Elsevier; 2016:chap 545.
Ferri FF. Testicular torsion. In: Ferri FF, ed. Ferri's Clinical Advisor 2018. Philadelphia, PA: Elsevier; 2017:1255-1255.
Kryger JV. Acute and chronic scrotal swelling. In: Kleigman RM, Lye PS, Bordini BJ, Toth H, Basel D, eds. Nelson Pediatric Symptom-Based Diagnosis. Philadelphia, PA: Elsevier; 2018:chap 21.
Palmer LS, Palmer JS. Management of abnormalities of the external genitalia in boys. In: Wein AJ, Kavoussi LR, Partin AW, Peters CA, eds. Campbell-Walsh Urology. 11th ed. Philadelphia, PA: Elsevier; 2016:chap 146.
Reviewed By: Jennifer Sobol, DO, urologist with the Michigan Institute of Urology, West Bloomfield, MI. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.