A twisted testicle, which is also called testicular torsion, occurs when the testicle rotates on the spermatic cord. One or both testis can be affected. The cord provides the blood supply to the testicle. Because the blood supply to the testicle is cut off, the tissue can die. If this occurs, male fertility can be affected.
Symptoms include sudden, severe pain. There may also be abdominal pain and nausea. The scrotum may also appear swollen, and the testicles may be higher than normal. Although a twisted testicle can occur at any age, including infancy, it is most common in adolescent males. Because immediate treatment is needed, it is considered a medical emergency.
The cause of twisted testicles is not clearly known. There appears to be a trait some males inherit, however, which allows the testicles to rotate inside the scrotum. It most commonly occurs during sleep. An injury to the testicles may also cause the condition. Once a male has this happen, he is at an increased risk of the condition happening again.
A diagnosis can often be made after a physical exam. An ultrasound may also be recommended to check for reduced blood flow to the testicle. Blood and urine tests may be ordered to rule out other conditions, which can cause pain in the testicles.
In some males, the condition will reverse itself spontaneously. Pain will subside, and the testicle becomes untwisted. Even if the testicle becomes untwisted, a doctor should still be consulted to determine if treatment is needed to prevent the condition from developing again.
If the condition has not reversed itself, surgery is the main treatment. Occasionally a physician may try manually untwisting the testicle. Surgery may still be needed to prevent the condition from developing again.
Surgery is done under anesthesia. The scrotum will be cut, and the testicle will be untwisted. If some of the tissue has died, it will need to be removed. In some cases, the entire testicle has to be removed. If the testicle is saved, it will be stitched to the wall of the scrotum to prevent the twisting from happening again.
The success rate of surgery and chance of saving the testicle depends on how quick the surgery was performed. Research indicates that if surgery is performed within the first six hours of a twisted testicle, the testicle can be saved about 90 percent of the time. The success rates drop to about 50 percent if surgery occurs after 12 hours. There is only about a 10 percent chance of saving the testicle if surgery is performed after 24 hours.