Testicular torsion: symptoms, timing and what to do

Testicular torsion is a urological emergency: the testis rotates on its own axis and its blood supply is strangled. If it is not diagnosed and treated quickly it can lead to atrophy (death) of the testis. The typical symptom is sudden, extremely severe pain in one testis. With this kind of pain, you must go to the emergency department immediately: it is a race against time, and the first few hours are decisive.

Why time is everything

With torsion, all the blood flowing to the testis — which passes through the spermatic cord — is cut off. From that moment the testis is deprived of oxygen (ischaemia). The more time passes, the lower the chance of saving it: acting within the first few hours gives the best chance of recovery. This is why torsion is not a “wait and see” situation, but one for the emergency department at once.

Who it affects

Testicular torsion can occur in childhood and in adulthood, but it has a peak frequency between the ages of 10 and 25. It therefore particularly concerns adolescents and young men — one reason it matters that boys (and parents) know how to recognise its main symptom.

Causes

The testis twists along its longitudinal axis, usually because the ligament anchoring it to the scrotum is congenitally weaker. This is a predisposing anatomical defect: the testis is too “free” to rotate within the scrotal sac. This is why torsion can occur even spontaneously, without any trauma.

Symptoms: how to recognise it

The typical picture is characteristic and rapid in onset:

• Sudden, extremely severe pain in one testis
• Pain radiating along the groin
• Swelling of the scrotum
• Elevation of the testis, drawn upward towards the groin

Faced with sudden, acute testicular pain of this kind, there is only one rule: emergency department, immediately. Do not wait for it to pass.

Diagnosis

The diagnosis is essentially clinical: the specialist's examination. When torsion is suspected, a testicular colour Doppler ultrasound is performed at once to assess blood flow to the testis. But investigations must never delay treatment: the speed of intervention is the decisive factor.

Treatment

Treatment, carried out by the specialist, has two possible levels:

• Manual detorsion: the immediate manoeuvre that “untwists” the testis and repositions it correctly in the scrotal sac
• Orchidopexy (surgery): if manual detorsion fails, surgery is performed to position and anchor the testis in the scrotum, resolving the torsion and preventing further episodes

Frequently asked questions about testicular torsion

Is testicular torsion an emergency?

Yes, it is a full urological emergency. Deprived of blood, the testis suffers and can die. With sudden, severe testicular pain you must go to the emergency department immediately, without waiting for the pain to pass on its own.

How much time is there to save the testis?

A few hours. Acting within the first hours of the onset of pain gives the best chance of saving the testis; every hour that passes reduces it. Torsion must be treated as a race against time.

How is testicular torsion recognised?

The main sign is sudden, extremely severe pain in one testis, radiating along the groin, followed by scrotal swelling and elevation of the testis. With these symptoms, there is no point attempting a diagnosis at home: go to the emergency department.

Why does the testis twist?

In most cases because of a congenital anatomical predisposition: the ligament anchoring the testis to the scrotum is too weak and the testis can rotate freely. This is why torsion can occur even spontaneously, without trauma, sometimes even during sleep.

Does the testis still work after a torsion?

It depends on how quickly it is treated. If the torsion is resolved early, the testis can fully recover its function. If treatment is delayed and the testis atrophies, its function (sperm and testosterone production) may be compromised — one more reason not to lose time.

With acute testicular pain, do not wait: go to the emergency department at once. For a non-urgent andrological assessment you can ask Prof. Natali for a consultation or book an appointment at his practices in Florence and Empoli, Italy.

The information on this page is provided for general educational purposes and does not replace a medical examination, which remains the only diagnostic tool for correct and effective treatment.