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Testicular torsion

Definition

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.

Alternative Names

Torsion of the testis; Testicular ischemia; Testicular twisting

Causes, incidence, and risk factors

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.

Symptoms

  • 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
  • Lightheadedness

Additional symptoms that may be associated with this disease:

Signs 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 partially twisted.

Treatment

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 testicles 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.

Expectations (prognosis)

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, the testicle may lose its ability to function if torsion has lasted fewer than 6 hours.

Complications

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 restricted for an extended period.

Calling your health care provider

Get emergency medical attention if you have symptoms of testicular torsion.

Prevention

Take steps to avoid injury to the scrotum. Many cases cannot be prevented.

References

Elder JS. Disorders and anomalies of the scrotal contents. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 539.

Ban KM, Easter JS. Selected urologic problems In: Marx JA, Hockberger RS, Walls RM, et al, eds. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 8th ed. Philadelphia, Pa: Mosby Elsevier; 2013:chap 99.

Wampler SM, Llanes M. Common scrotal and testicular problems. Prim Care. 2010;37:613-626.

Barthold JS. Abnormalities of the testes and scrotum and their surgical management.In: Wein AJ, ed. Campbell-Walsh Urology. 10th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 132. 


Review Date: 10/2/2013
Reviewed By: Scott Miller, MD, Urologist in private practice in Atlanta, Georgia. Also reviewed by David Zieve, MD, MHA, Bethanne Black, and the A.D.A.M. Editorial team.
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