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Testicular torsion is the twisting of the tube, called the spermatic cord, which leads to the testicle. When this happens, little or no blood is able to flow to that area. This occurs in about one in every 4,000 males. This condition is a surgical emergency. The testicle can only survive for about six to eight hours without any blood flowing to it. After that, the tissues are damaged, and the testicle no longer works.
Testicular torsion can happen at any age. However, it is most common in newborns or boys going through puberty. When testicular torsion happens during the newborn period, there is a very high chance that the testicle has already been severely damaged and may not be saved.
There are no specific causes of testicular torsion.
The testicles develop inside the belly and drop down into the scrotum around the sixth month of pregnancy. Once the testicle drops into the scrotum, it attaches to the inside. When a testicle does not drop down into the scrotum (undescended testicle), it does not attach correctly, which causes a higher risk of twisting.
When the cord twists, it blocks the blood leaving the testicle, which causes swelling and pain. This can lead to permanent damage to the testicle. Once testicular torsion has occurred on one side, there is a higher chance it can occur on the other side. This can happen anywhere from a few weeks to months later.
Symptoms can vary based on the age of the child.
Testicular torsion is a surgical emergency. If the twist has been present for more than eight hours, there is only a 60% chance of saving the testicle.
The only treatment for testicular torsion is surgery. During the surgery, the surgeon untwists the spermatic cord to return blood flow to the testicle. They stitch the testicle in place to prevent any twisting in the future. They often stitch the other testicle because there is a chance of the twist happening on the other side. This happens most often within six months of the first side twisting.
Newborns with scrotal swelling should see their pediatrician or come to the Emergency Department. There are some common causes of scrotal swelling in babies that do not involve twisting of the spermatic cord.
Older children or adults who develop testicular pain not caused by recent injury should go to the Emergency Department right away. The best chance to save the testicle is within four to six hours of it twisting. We have clinical protocol in place to coordinate and expedite care between the Emergency Department, the Urology service and the Anesthesia team in the operating room. Our goal is to perform surgical repair within four hours of the patient arriving at the hospital. It is important not to eat or drink on the way to the hospital in case surgery is needed right away.
In the Emergency Department, an ultrasound is usually ordered to help see if any blood is flowing to the testicle. If there is no blood flow found, the Urology team will recommend surgery to untwist and secure the testicle.
Since there are no specific causes of testicular torsion, you cannot prevent it.
In some instances, children may have intermittent twisting and untwisting of the testicle (known as torsion-detorsion). Preventive surgery to secure the testicles is sometimes offered to prevent full twisting of the spermatic cord that could result in loss of the testicle.
Since there is a high chance of testicular torsion in undescended testicles, a child may have surgery on the testicle to prevent it from ever twisting.
Following surgery, care instructions would include:
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Last Updated 12/2023
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