---
title: "Testicular Torsion Medicine"
url: https://alsuprun.com/blog/torsion-medicine/testicular-torsion-medicine-27/
author: "Editorial"
date: 2026-09-21T06:31:28+00:00
categories: ["torsion medicine"]
tags: []
---

# Testicular Torsion Medicine

Testicular torsion is a true urologic emergency that requires immediate recognition, referral, and surgical exploration. Salvage of the affected testicle decreases with prolonged ischemia, reflecting the narrow therapeutic window emphasized by international guidelines.

 This occurs when a testicle rotates, twisting the spermatic cord that supports the testis in the scrotum, and obstructs blood flow. Symptoms typically include sudden severe unilateral scrotal pain and loss of cremasteric reflex.

 

## Testicular Torsion

 It is important to remember that testicular torsion is a urologic emergency and should be treated as such. If left untreated, the twisted testicle can die within six hours due to blocked blood flow. This is because the testicle gets its blood supply through the spermatic cord, which becomes cut off when the testicle is twisted.

 [![Rejuvenate your whole body & balance your health without medications - now remotely!](https://alsuprun.com/blog/wp-content/uploads/BioresonanceTopAd.png)](https://www.bioresonance.rent) Symptoms of testicular torsion include sudden-onset pain in the scrotum and a reddish or purple coloration in the skin in the area of the painful testicle. If the pain is very severe, it can cause vomiting or passing of blood in the scrotum. The pain usually comes on quickly and lasts for a few hours. The testicle will also feel very heavy and swollen, and it may feel warm or cold to the touch.

 The scrotum should be examined, and the physician will check for a blue dot sign, which is a small patch of bluish discoloration on the scrotal sac at the superior pole of the vulva, caused by cyanotic appendages (which serve no functional purpose). This sign is pathognomonic for testicular torsion and can be confirmed with color Doppler ultrasound.

 The physician will also do a physical examination and compare the affected testicle to the unaffected one. The swollen testicle will be slightly erect and elevated above the other testicle, which will be more slouched. The presence of a cremasteric reflex is not reliable, as the pain of torsion does not relieve with elevation of the testicle. Prehn’s sign is also unreliable, since the pain of torsion is usually not relieved with stroking the ipsilateral thigh.

 [![](https://alsuprun.com/blog/wp-content/uploads/ForeverYoungYouWannaBe.png)](https://alsuprun.com/services.html#Contact) A history of previous testicular trauma or a family history of testicular torsion increases the risk of torsion. Infants can have torsion, though it is more common in older boys. Newborns with torsion are most likely to lose their affected testicle, because they don’t respond to pain as well as adults.

 If the affected testicle isn’t saved, surgery will need to be done. The surgeon will sew stitches around the testicle, and this should prevent torsion from occurring in the future. If the affected testicle is removed, a prosthetic testicle can be put in place later. This type of prosthesis is made of silicone and filled with salt water, and it looks and feels like a normal testicle.

 

## Diagnosis

 Symptoms of testicular torsion include sudden, severe pain on one side of the scrotum (the pouch that holds the testicles), which is sometimes accompanied by nausea and vomiting. The pain is usually sharp and occurs in the absence of trauma or injury to the testicle or scrotum. Although rare in newborns, testicular torsion can occur at any age and often occurs more frequently during adolescence.

 In cases of suspected torsion, the physician should evaluate the patient immediately with a physical exam. The patient should be asked about the time of onset of symptoms and whether there are associated urinary or abdominal symptoms. Patients may also describe intermittent pain that resolves spontaneously, known as intermittency. A urinalysis can be useful to rule out other conditions such as infectious epididymitis, hematoma, or strangulated inguinal hernia.

 Doppler ultrasound of the testicle can be helpful in diagnosing torsion. It is important to perform the test with the patient lying on his or her back and comparing the asymptomatic testicle with the painful testicle. Doppler ultrasound can identify decreased blood flow to the testicle and help in determining if the torsion is severe and requiring immediate surgical management.

 During surgery, the surgeon will attempt to remove the torsed testicle and reconnect its blood supply to the spermatic cord. This procedure, called an orchiectomy, is typically an outpatient procedure. Occasionally, the urologist will need to use stitches to repair the scrotal incision. Stitches are not visible and do not affect sexual function or performance.

 [![](https://alsuprun.com/blog/wp-content/uploads/RadionicMerch.png)](https://alsuprun.com/merch.html) Although there have been improvements in the diagnosis and treatment of testicular torsion, it remains a surgical emergency. The sooner the testicle is repaired, the higher the chance of saving it. In cases where the twist has been present for more than 8 hours, the likelihood of saving the testicle drops significantly. Therefore, it is essential that all patients with scrotal pain be evaluated by a urologist in the emergency department to evaluate for torsion and consider operative exploration.

 

## Treatment

 Testicular torsion is a common and potentially deadly condition that requires immediate attention. It can be caused by the rotation and twisting of the testicle, which causes swelling and cuts off the blood supply. Testicular viability declines rapidly six hours after onset of symptoms, so early diagnosis is critical. Approximately 1 in 4000 men under the age of 25 will experience testicular torsion each year. It is the most common reason for scrotal pain and accounts for a significant number of visits to the emergency department.

 When patients describe severe, unilateral testicular pain they should be evaluated for torsion. The pain should be described as sudden, sharp and intense. The patient should be asked about other symptoms and the scrotum, testicles, abdomen and groin should be examined. The diagnosis of testicular torsion is based on history and physical examination; no laboratory testing is necessary.

 In a patient with suspected testicular torsion, the emergency physician should immediately explore the scrotum and remove the testis, if it is still viable. This may require general anesthesia. Ideally, the patient should be admitted to the hospital for this purpose.

 Symptoms of torsion include swelling, redness and warmth of the testicle and pain that is worse when lying down or exercising. Some patients will describe a feeling like they have to urinate right away and will experience nausea or vomiting. Newborn infants can have testicular torsion, but it is less common than in older children. It is important to note that the spermatic cord twist in newborns is different from adults and can sometimes be missed. Infants can present with a hard scrotal mass rather than an painful, enlarged testicle and their pain may be less intense.

 Some risk factors for testicular torsion are family history, being overweight and having a bell clapper deformity (the testis attaches high on the spermatic cord and can rotate). Blocked blood flow from the testicle can lead to permanent damage within several hours. The loss of a testicle also affects fertility in men and can cause an inability to father children.

 

## Prevention

 The urologist will usually try to save the testicle by performing a procedure called orchiopexy, which involves sewing the bottom of the testicle to the wall of the scrotal sac (the loose bag under the penis that contains the testicles). This reduces the likelihood of future twisting. If the testicle cannot be saved, it will need to be removed. The urologist will also sew a band around the other testicle to prevent the possibility of future torsion in that area as well.

 Unfortunately, it’s impossible to fully prevent testicular torsion. Some people have a genetic trait that makes their testicles move more freely in the scrotum, and some experience sudden pain when they exercise or get too hot, which triggers the twisting process. Others have undescended testicles, which don’t attach properly to the scrotum and can spin easily. Then there are people who have injuries to their groin, like kicks during sports or falls, that can jiggle the testicle and cause it to twist.

 Some people think that testicular torsion only happens during physical activity, but the truth is that it can happen anytime, even during rest. A twist can occur during sleep, which is referred to as nocturnal testicular torsion. Other times it occurs during sudden activity, such as a sprint or a jump, when the body suddenly shifts or flexes in ways that can make the testicle rotate and cut off blood flow.

 Even when a person isn’t physically active, the sudden pain that can result from testicular torsion may wake them up or feel like a simple cramp. The key is to recognize the symptoms and seek emergency care as soon as possible, since the sooner the twisted testicle is untangled, the better chance it has of being saved.

 It’s important to remember that even if the testicle has been saved, it will likely not grow back, because the damage has already been done. Therefore, most patients with testicular torsion will need a surgical procedure called orchiopexy to prevent future problems. It’s also a good idea for all people to be aware of the warning signs, so they can get help as soon as possible, especially young boys who might have scrotal pain in the middle of the night or early in the morning.

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