Testicular torsion

Overview

“Torsion” means twisting. In this condition, the testicle twists along its longitudinal axis. This blocks the blood flow to the testicle, causing acute circulatory insufficiency and the sudden onset of severe testicular pain. The testicle can't bear to be touched. The emergency services should be contacted without delay if these symptoms occur.

Symptoms

Main symptom

• Testicular pain
  • Sudden, excruciating pain
  • Radiates into the groin and lower abdomen
  • Worsens if testicle is touched or raised
  • Pain can be bad enough to cause loss of consciousness

Other symptoms

• Swollen and red scrotum
• Affected testicle is higher than the other one
• Nausea and vomiting

Long-term damage

• Death of testicular tissue
• Shrinking (atrophy) of the testicle
• Infertility (if both testicles are affected)
• Reduced production of male sex hormones

Causes and treatment

Causes

• Process
  • Testicle twists along its longitudinal axis (often several times)
  • Epididymis and spermatic cord are also affected
  • Blocks the blood flow (testicular infarction)
• Risk factors
  • Undescended testicles, retractile testicles
  • Congenital weakness in testicle attachment
  • Tissue holding the testes to the scrotum is underdeveloped
• Triggers
  • Often can't be identified, can happen at any time of the day or night
  • Everyday movements, e.g. cycling, running around, etc.
  • Mechanical manipulation

Further treatment by your doctor / in hospital

Possible tests

• Examination of testicles (restricted due to pain)
• Scrotal ultrasound (sonography)

Possible therapies

• Operation
  • Must be done within 4 to 6 hours
  • “Untwisting” and stitches to fix the testicle in place
  • Fixing of the other testicle, if necessary (prevention)
  • Important: testicular torsion can occur again, even after the testes have been fixed in place

What can I do myself?

• Take rapid action when acute testicular pain occurs (see below)

When to see a doctor?

• Emergency
  • Extreme pain and swelling in scrotum
  • Testicle can hardly be touched
  • Rapid action is needed, otherwise the reduction in blood flow can lead to long-term damage
  • Severe pain in the groin and lower abdomen
• Hard, rough thickening/knots in the testicle
• Blood in sperm

Synonyms

testicular torsion, twisting of the testicle, testicular infarction, testis infarction