When a testicle (testis) twists around in the scrotum, the condition is called torsion of the testis. An emergency operation is usually needed to treat this condition.
Understanding the testes
The two testicles (testes) lie in your scrotum. The spermatic cord is like a flexible tube that goes from each testis to your lower tummy (abdomen). The spermatic cord contains the blood vessels that take blood to and from your testis and your vas deferens which takes sperm from your testis to your penis.
You can normally feel the spermatic cord through the skin of your scrotum just above your testis. It feels like a thick piece of string. The testes can move around a little in the scrotum but cannot usually move enough to twist around fully.
What happens in a twisting (torsion) of the testis?
In some people the tissues that surround the testicle (testis) in the scrotum are lax. Therefore, the testes can move around in the scrotum more than usual. If a testis twists around, the spermatic cord has to twist around too as it is fixed higher up. If this happens, the blood flow to the testis is blocked in the twisted spermatic cord. (This is like a hosepipe attached to a tap. The water will not flow if the hose becomes twisted on itself.)
A testis with its blood supply cut off is likely to become damaged and die unless the blood flow is quickly restored.
Who develops torsion of the testis?
Torsion of the testicle (testis) most commonly occurs in teenage boys, shortly after puberty. Newborn babies and younger children sometimes develop this problem. It is uncommon over the age of 25 but does occur sometimes in older adults and can occur at any age.
What are the symptoms of torsion of the testis?
The typical symptom of torsion of the testicle (testis) is severe pain that develops quickly - within a few hours, often much more quickly. The pain is in the affected testis but you may also feel it in the middle of your tummy (abdomen), due to a shared nerve supply. In about half of cases, symptoms start in the night and the pain wakes you from sleep. The affected testis soon becomes tender, swollen and inflamed.
What is the treatment for torsion of the testis?
Twisting (torsion) of the testicle (testis) is an emergency. If the blood supply to your testis is cut off for more than about six hours then permanent damage is likely to occur. An emergency operation is usually done. A small cut is made in the skin of your scrotum to expose the testis. The affected testis and spermatic cord are untwisted. The testis is then stitched to the surrounding tissue and fixed in position to prevent torsion happening again. The other testis is also fixed at the same time, as it has a higher-than-average chance of twisting in the future.
The sooner the operation is done, the better the outlook to save your testis. Ideally, the operation should be done within 6-8 hours of symptoms starting. Sometimes the affected testis is removed if the operation is done too late and the testis has died.
Although the operation is usually done as an emergency, it is a fairly small operation which does not take very long.
Occasionally, the twisted testis can be untwisted by a doctor, without needing an operation. However, this procedure can be painful and often not successful. An operation is usually needed afterwards.
If you are worried about your appearance after you have had a testis removed, it may be possible for a surgeon to put a false testis into the scrotum.
Partial torsion and warning pains
Some boys and men have warning pains in a testicle (testis) every now and then, before a full-blown twisting (torsion). These occur suddenly, last for a few minutes, then ease just as suddenly. These pains occur if a testis twists a little and then returns back to its normal place on its own.
An operation to fix the testes in place is usually advised if these warning pains occur. This is because it is likely that at some point a testis will twist fully and emergency surgery will be needed. A planned operation to fix the testes is preferable to waiting for a full-blown torsion to occur.
Further reading and references
Guidelines on Paediatric Urology; European Association of Urology (2015)
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