Testicular Torsion

Overview

What is testicular torsion?

Testicular torsion is a painful, very serious condition in which a male’s testicular blood supply (the spermatic cord) gets twisted and cuts off blood flow to the testicle. It is a medical emergency and if not treated right away—within six hours—you can lose the testicle.

The testicles are the reproductive organs in a sac (scrotum) below the penis that make hormones and sperm. Therefore, this condition has the potential to affect your fertility potential.

Who gets testicular torsion?

Torsion is a rare but very serious condition. It affects about one in 4,000 males under the age of 25. It is most common in adolescents between the ages of 12 and 18, a group that accounts for 65 percent of all cases.

It can affect newborns within the first year of life. This condition can also affect men over 25, although that is rare.

Testicular torsion is usually a spontaneous event.

Symptoms and Causes

What causes testicular torsion?

There is usually no cause that precedes testicular torsion, although an injury to the testicle has been associated with it.

Another cause of testicular torsion is a condition called “bell clapper” deformity. In most males, a testicle would not be able to twist because it is firmly attached to the scrotum. For a male who is born with bell clapper deformity, his testes are hanging in the scrotum and can swing freely, like a clapper in a bell. This can then lead to twisting. This deformity affects both testes, although it is very rare for twisting, or torsion, to occur in both sides of the scrotum at once.

What are the symptoms of testicular torsion?

A main symptom of testicular torsion is the sudden onset of severe testicular pain. It can occur when you are awake or asleep, standing or sitting. Torsion almost always affects only one testicle, and the left testicle is more commonly affected.

You should seek medical attention right away if you or your child is suffering from any of these symptoms:

  • Sudden severe pain in one testicle that is not caused by an injury or accident
  • Swelling on one side of the scrotum that is painful and visible to the eye
  • A visible lump in the testicle

Diagnosis and Tests

How is testicular torsion diagnosed?

Testicular torsion can usually be diagnosed by a urologist based on a physical examination, description of your symptoms, and your medical history. Due to the severity of the condition, a quick diagnosis is vital so the person does not lose his testicle. Occasionally, if a urologist is not available initially, scrotal ultrasonography with doppler signaling will be performed in order to determine the presence of blood flow within the testicular tissue.

An X-ray or tests beyond a physical examination will only be used if the patient has unusual symptoms. In that case, a urinalysis or an ultrasound to check blood flow to the area may also be done.

Management and Treatment

How is testicular torsion treated?

A testicular torsion must be treated with surgery, although an emergency room doctor may try to manually untwist the cord. Even in these cases, surgery will be needed. During surgery for testicular torsion, the surgeon will untwist the testicle, restoring blood flow to the area. He or she will then secure it with sutures to the inner scrotal wall to prevent future torsions.

The surgeon will usually perform the surgery through the scrotum, although sometimes they will need to make an incision through the groin. They will also fix the unaffected testicle to prevent future torsion because a bell clapper usually exists on both sides.

Studies have shown that if surgery is delayed more than six hours, it is very likely the testicle will need to be removed. This occurs in more than 75 percent of cases after 12 hours.

Unfortunately, newborns with testicular torsion often lose their testicle because the blood flow has been interrupted far too long and the tissue has died (become infarcted). Surgery will still be performed to remove the dead testicle and suture the other testicle so it does not become twisted later in life.

Outlook / Prognosis

What is the outlook for testicular torsion?

If testicular torsion is treated right away—at best within six hours—the testicle may be saved. But if blood flow is cut off for more than six hours, the testicle may lose its ability to function. For this reason, it is very important to seek medical attention at the first symptoms of testicular torsion.

Last reviewed by a Cleveland Clinic medical professional on 08/22/2019.

References

  • Urology Care Foundation. What is Testicular Torsion? (https://www.urologyhealth.org/urologic-conditions/testicular-torsion) Accessed 8/23/2019.
  • The Nemours Foundation, TeensHealth. Testicular Torsion. (https://kidshealth.org/en/teens/torsion.html) Accessed 8/23/2019.
  • Merck Manual Professional Version. Testicular Torsion. (https://www.merckmanuals.com/professional/genitourinary-disorders/penile-and-scrotal-disorders/testicular-torsion) Accessed 8/23/2019.
  • Rampaul MS, Hosking SW. Testicular torsion: most delay occurs outside hospital. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2503009/) Ann R Coll Surg Engl. 1998; 80: 169-172. Accessed 8/23/2019.
  • Ringdahl E, Teague L. Testicular torsion. (https://www.aafp.org/afp/2006/1115/p1739.html) Am Family Physician. 2006 Nov 15;74(10):1739-1743. Accessed 8/23/2019.

Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy