Table of Contents
Definition of Testicular Torsion
Testicular torsion is very painful and can result in loss of the testicle due to strangulation (cutting off the flow of blood to the testicle). Testicular torsion may occur as a result of injury or may occur spontaneously (without apparent cause) and is most common in boys between the ages of 8 and 14.
Normally connective tissues firmly attach the epididymis to the scrotum; in testicular torsion this attachment either did not exist (congenital) or broke free with exertion or a blow to the testicles.
Testicular torsion is a medical emergency that requires urgent treatment from a doctor.
The key symptoms of testicular torsion are pain, swelling, and discoloration (cyanosis) o f the scrotum. Symptoms usually appear suddenly, thoughsome boys or men have recurring symptoms over time. Because of the structure of the spermatic cord, testicular torsion most often affects the left testicle.
Chronic symptoms suggest congenital detachment of the epididymis from the scrotum. The diagnostic path includes careful physical assessment of the testicles, usually by a urologist. Ultrasound (usually Doppler ultrasound) can confirm the diagnosis.
Treatment, when diagnosis comes within six to eight hours of the first symptoms, is emergency surgery to restore the testicle to its normal position and attach it to the scrotum (orchiopexy). The testicle cannot survive more than six to eight hours after symptoms emerge; after this time necrosis (death of the tissue) sets in and the only treatment is to remove the testicle (orchiectomy).
With rapid and appropriate treatment the urologist can save the testicle about 80 percent of the time.
However, testicular atrophy (wasting) and necrosis (tissue death) remain possible for up to six months after the surgery to remedy testicular torsion.
The longer the time between the onset of symptoms and surgery, the greater the likelihood for impaired fertility even when the urologist can save the testicle. This is because the sperm that escape into the tissues of the testicle establish or activate the immune response, which produces antibodies to the man’s own sperm that then attack the sperm as the testicles produce them.
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