Glickman Urological & Kidney Institute

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Testicular Torsion

Testicular torsion is a twisting of a testicle that cuts blood flow in the testicular artery that feeds the testicle.

The Glickman Urological and Kidney Institute consists of world class physicians and surgeons skilled in treating problems such as testicular torsion. However, if the problem occurs, timely treatment is essential. Patients who suspect they may have testicular torsion should seek treatment at the closest medical facility or emergency room.

Testicular torsion is a twisting of a testicle that cuts blood flow in the testicular artery that feeds the testicle. It is a medical emergency that requires immediate attention. The most common symptom is a sudden onset of pain in the scrotum that holds the testicles. Sometimes the pain grows slowly but this is not usual. The scrotum will swell.

About a third of men will experience nausea and vomiting and perhaps a third will experience abdominal pain. Up to 16% will develop a fever and a small percentage (4%) will have the urge to urinate.

The problem may strike about 1 in 4,000 males in the U.S. annually, most of whom are under 30 years old. The majority of those affected are between the ages of 12 and 18. The peak age is 14. About half the instances of testicular torsion occur during sleep and are thought to be caused by muscle spasms. A large percentage of torsion events are tied to physical activity or an injury.

The symptoms are highly suggestive of the problem. An examining physician can often diagnose the problem from the symptoms and by palpating (feeling) the testicles. When these measures do not yield a positive diagnosis, color doppler ultrasonography may be used to determine if blood is flowing the testicle and where the blockage might be. Sonography bounces sound waves off of tissues and structures and uses the echoes to form an image, a sonogram.

Mild analgesics are usually administered to reduce pain once the problem has been diagnosed. Some physicians will delay analgesics and use the relief of the pain to indicate that the problem has been resolved. The physician stands at the patient’s feet, grasps the testicle between the thumb and forefinger and manually rotates it back to its proper position. This will resolve the problem in about 70% of cases.

When surgery is needed, an incision is made in the scrotum and the testicle is rotated. The surgeon may then place a few sutures in the testicle and the adjacent testicle to stabilize them and prevent the problem from recurring. When these procedures are conducted soon after the problem appears, nearly all patients will recover.

If action is delayed and the blood supply to the testicle is interrupted for 6 hours or longer, the testicle may atrophy and need to be removed. In some instances the testicle may atrophy even after the problem has been corrected. The absence of one testicle does not reduce sexuality or prevent a man from fathering children. The absence of blood flow for a prolonged period also increases the risk of infection to the testicle and scrotum.

If testicular torsion occurs, timely treatment is essential. Patients who suspect they may have testicular torsion should seek treatment at the closest medical facility or emergency room.

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This information is provided by Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition.

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