Testicular Torsion is when the testes twist around the spermatic cord. When this happens, it cuts off the blood flow to the testicle. 

It is a True Urological Emergency.

What Happens Normally?

  • The testis are a pair of two organs that hang in a pouch of skin called the scrotum. 
  • This is where sperm and male sex hormone (testosterone) are made. 
  • The blood supply for each testicle comes from the spermatic cord. This cord also contains the vas deferens, which carries sperm from the testicles to the urethra.
  • Torsion tends to happen on the left side more than the right. Most often, torsion is only on one side. Only 2 in 100 men with torsion have it in both testes.

What are the Signs of Testicular Torsion ?

  • Most common sign is sudden, severe pain on one side of the scrotum.
  • The testes should be about the same size. Sudden enlargement and change in colour (reddening / darkening) are issues of concern.
  • It may be associated with nausea and vomiting.   
  • Slow-onset pain in the testicle, over many hours or days, can be a sign of torsion. This is less common.

Complications

The testicle will shrink if the blood supply isn't restored within 6 hours. With no blood, the testicle could die. When the testes die, the scrotum will be very tender, red, and swollen. Often the patient won't be able to get comfortable.

Any pain or discomfort in the testes is a sign to get medical help right away. See a Urologist even with no swelling or change in skin colour.

Causes of Testicular Torsion?

  • Not a common problem. 
  • It happens in about 1 in 4,000 males under the age of 25. 
  • It can also happen in newborns and in older men.
  • In most males, a testicle can't twist because the tissue around it is well attached. 
  • Physical activity doesn't cause torsion. It may happen during exercise, sitting, standing or even sleeping.

Diagnosis

  • Testicular torsion is often found after a physical exam by a Urologist.
  • Ultrasound can check blood flow to the testes. 

Treatment

  • Torsion must be treated quickly. Your urologist may do surgery if torsion is happening.
  • The spermatic cord needs to be untwisted (de-torsion) to restore the blood supply.
  • Lasting damage starts after 6 hours of torsion. One study found that nearly 3 in 4 patients need the testicle removed if surgery is delayed past 12 hours.
  • Ideally you should see a urologist for treatment. 
  • All patients with torsion will need surgery. 
  • If the testicle cannot be saved, the urologist will remove the testicle and sew stitches around the other testicle to prevent future torsion. This can only be determined at the time of surgery.

After Treatment

  • Whether the testicle is removed or not, surgery in the scrotum will take time to heal.
  • You may need to take pain medicine for a few days. 
  • Within a few days to a week, you should be able to return to work or school. 
  • It's helpful to avoid strenuous activity or exercise for several weeks.
  • Torsion of the other testicle can't be prevented by changes in activity or by taking medicine. Only sewing stitches around the testicle will prevent future torsion.
  • If the twisted testicle is left in place, it still might shrink a bit, since lasting damage may happen. Sometimes, if one testicle is removed, the other may grow larger than normal. This is known as "compensatory hypertrophy."

How will My fertility be affected after losing a testicle?

  • Only one working testicle is needed for normal fertility and male features. 
  • A single testicle can make normal amounts of sperm and testosterone. But studies show that up to one third of patients have a lower sperm count after a torsion.
  • Testicular torsion can also result in anti-sperm antibodies, which may change how the sperm work and move.
  • Some studies suggest that these men could have lower fertility, but this is rare.

How will losing a testicle or having a weakened testicle affect my lifestyle?

  • If you've lost a testicle or have a weakened testicle, you should be careful with the one that's left. 
  • Always wear protection when playing contact sports. 
  • Seek medical care if you have any discomfort or notice anything abnormal in the scrotum or remaining testicle.
  • It's a good idea to have your testosterone levels checked regularly as you get older.

Should I consider a testicular prosthesis?

A testicular prosthesis is used to restore the look and feel of a testicle that has been removed. 

One type is made of silicone and filled with salt water. 

Most often, the prosthesis is placed when a man is fully grown and through puberty.

If a smaller prosthesis is used in a young boy, an adult size would be needed later. This means more surgery. 

Surgery for a prosthetic testicle is often done months after the testicle is removed. The decision for a prosthesis is personal, and should be discussed with your urologist.

What Other Torsions can occur?

  • Torsion of the "appendix of the epididymis" or "appendix of the testicle" can occur. 
  • In this kind of torsion, twists are found in a small, upper part of the epididymis or testicle, causing infarction (death of that tissue). 
  • These parts of the testicle are from the embryo stage, and have no use in men. 
  • This kind of torsion is more common in prepubescent boys than testicular torsion. It is rare in older boys or men.