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Testicular Torsion

By Patrick J. Shenot, MD, Thomas Jefferson University

Testicular torsion is the twisting of a testis on its spermatic cord so that the testis’s blood supply is blocked.

What Is Testicular Torsion?

Testicular torsion usually occurs in boys between the ages of about 12 and 18 and sometimes occurs during infancy, but it can occur at any age. Abnormal development of the spermatic cord or the membrane covering the testis makes testicular torsion possible. With torsion, the testis usually dies within 6 to 12 hours after the blood supply is cut off unless the torsion is treated.

Severe pain and swelling develop suddenly in the testis. The pain may seem to come from the abdomen, and nausea and vomiting may develop. Sometimes fever develops. Affected people may need to urinate frequently.

Doctors may diagnose the condition based on a description of the symptoms and the physical examination findings. Alternatively, doctors may use imaging, usually ultrasonography, for diagnosis.

Testicular torsion is an emergency because the testis will die unless it is untwisted rapidly. Doctors may try to untwist the testis without surgery by rotating it within the scrotum. Occasionally, this procedure is successful and surgery is done later. However, usually the procedure is unsuccessful, and surgery to untwist the spermatic cord is required immediately. During surgery, whether done immediately or later, urologists usually secure both testes to prevent future episodes of torsion.

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