Medical City Healthcare - March 30, 2021

“Testicular torsion occurs when the testicle twists on itself and cuts off the blood supply to the testicle,” says Philip Ewing, MD, a Medical City Healthcare emergency medicine physician. “Sometimes it's related to injury, but not always—sometimes it's spontaneous.”

If left untreated, the testicle will eventually die due to lack of blood flow.

Dr. Ewing says the key is to make sure that the condition is detected and treated by a medical professional as soon as possible to save the testicle.

The causes of testicular torsion and who is at risk.

Testicular torsion affects about 1 in 4,000 males under the age of 25, but it can be present at birth and occur at any age. Because the condition is most common in adolescents between 12 and 18, Dr. Ewing has the following advice for parents:

“Naturally, some children are going to be embarrassed about a problem that involves their private parts,” he says. “They may not tell their parents, so it’s important for parents to know about this condition and encourage the child to tell us that there is a problem so that we can investigate it.”

Testicular torsion symptoms.

Pain and swelling are hallmark symptoms of testicular torsion, which should be treated as a medical emergency. Sudden, severe pain on one side of the scrotum (the pouch that holds the testes) is the most common sign. Testicular torsion in both testicles is rare and occurs in only about 2 out of 100 males.

Other signs of testicular torsion may include:

  • One testicle (more commonly the left) quickly becomes larger than the other
  • Changes in scrotum color, especially redness or darkening
  • Nausea and vomiting

Less commonly, slow-onset pain in a testicle, over many hours or days, can be a sign of torsion.

Dr. Ewing says the condition often becomes more noticeable in the evening and morning hours. If you have excruciating nighttime pain that won’t go away or wake up and feel that you slept poorly because of testicular pain that continued all night, those are signs that you need to seek medical treatment.  

Day or night, testicular pain or discomfort is always a good reason to call your doctor, even if there are no other symptoms.

Treatment for testicular torsion.

As with any emergency health issue, time plays a factor in the success of treatment for testicular torsion. While the testicle can be untwisted in the ER, patients will need surgery—ideally with a urologist—to prevent future twisting (torsion). The American Urological Association reported on a study showing that nearly 3 out of 4 patients need to have the testicle removed if surgery is not done within 12 hours.

“The biggest issue is making sure that the problem can be addressed as quickly as possible,” Dr. Ewing says. “The timeframe is a six-hour window to get diagnosed and treated … with an almost one-hundred percent chance that you can save the testicle. But once that sixth hour has passed, the chance of saving the testicle goes down with each hour and eventually gets to the point of no return.”

Fast, comprehensive diagnosis and treatment for testicular torsion is available through hospital-based emergency rooms.

“The most important thing is making sure you're getting to a facility where this problem can be taken care of,” says Dr. Ewing. “Unfortunately, clinics, freestanding ERs and urgent cares are not the best place because they don't have the resources to take care of the problem. Coming to a place where you can get the diagnosis and take care of it as quickly as possible is going to result in the best outcome.”

Medical City Healthcare provides comprehensive emergency services across North Texas.

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