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Testicular Torsion: Causes, Symptoms and Treatment

Testicular torsion is an acute twisting of the testicle around its own axis, cutting off blood supply and representing a urological emergency requiring immediate surgery.

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Things worth knowing about "Testicular Torsion"

Testicular torsion is an acute twisting of the testicle around its own axis, cutting off blood supply and representing a urological emergency requiring immediate surgery.

What is Testicular Torsion?

Testicular torsion is a serious urological emergency in which the testicle rotates around the spermatic cord, cutting off its blood supply. Without prompt treatment, the resulting lack of blood flow can cause permanent damage to the testicular tissue within hours. The condition most commonly affects adolescent males between the ages of 12 and 18, but it can occur at any age, including in newborns.

Causes and Risk Factors

Testicular torsion most commonly occurs due to an anatomical abnormality known as the bell-clapper deformity, in which the testicle is not adequately anchored within the scrotum and is therefore free to rotate. Additional risk factors include:

Family history of testicular torsion (genetic predisposition)
Previous episodes of scrotal pain (intermittent torsion)
Physical activity or trauma to the genital area
Cold temperatures triggering the cremaster muscle reflex

In many cases, testicular torsion occurs without any identifiable trigger and may even happen during sleep.

Symptoms

The hallmark of testicular torsion is a sudden onset of severe pain in one testicle. Common symptoms include:

Sudden, severe unilateral testicular pain
Swelling and redness of the scrotum
High-riding testicle (caused by shortening of the twisted spermatic cord)
Nausea and vomiting
Lower abdominal pain
Absence of the cremasteric reflex on the affected side

Symptoms typically develop abruptly and worsen rapidly. Any delay in treatment significantly increases the risk of permanent testicular loss.

Diagnosis

Diagnosis of testicular torsion is primarily clinical and must be made quickly. The following approaches are used:

Physical examination: Assessment of pain localization, testicular position, and the cremasteric reflex
Color Doppler ultrasound: Imaging to evaluate blood flow to the testicle -- absent blood flow strongly suggests torsion

Important: When testicular torsion is clinically suspected, imaging must not significantly delay surgical exploration. In cases of doubt, the guiding principle is: operate before it is too late.

Treatment

Testicular torsion is a surgical emergency. The only effective treatment is immediate surgical exploration of the scrotum (scrototomy):

Detorsion: The twisted testicle is manually untwisted to restore blood flow.
Orchiopexy: The testicle is surgically fixed to the scrotum on both sides to prevent future torsion. The contralateral (opposite) side is fixed prophylactically at the same time.
Orchiectomy: If the testicle is irreversibly damaged (necrotic), it must be surgically removed.

The viability of the testicle depends heavily on the time elapsed between onset of symptoms and surgery:

Within 6 hours: salvage rate approximately 90-100%
6-12 hours: approximately 50%
After 24 hours: less than 10%

Complications

If testicular torsion is not treated promptly, the following complications may occur:

Loss of the affected testicle (testicular atrophy or orchiectomy)
Impaired fertility
Psychological distress related to testicular loss

References

European Association of Urology (EAU): Guidelines on Urological Trauma and Scrotal Emergencies. www.uroweb.org
Favorito LA et al. - Testicular torsion: aspects of epidemiology, etiology, clinical diagnosis and treatment. Int Braz J Urol. 2020.
Visser AJ, Heyns CF. - Testicular function after torsion of the spermatic cord. BJU International, 2003.

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