Testicular torsion is a time-sensitive medical emergency that occurs when the spermatic cord twists around the testicle. This twisting action severely restricts or completely cuts off the blood supply to the testicle, causing ischemia. This condition requires immediate professional medical care to restore circulation and prevent the potential loss of the organ.
Recognizing the Signs of Testicular Torsion
The most telling sign of testicular torsion is the sudden onset of severe, excruciating pain in one testicle. This pain often begins without any obvious trigger and is persistent, distinguishing it from other causes of scrotal pain. The affected side will likely show swelling and tenderness, and the scrotum may become red or darkened over time. A physical sign medical professionals look for is an elevated testicle positioned at an unusual, horizontal angle within the scrotum. Patients may also experience accompanying symptoms such as nausea, vomiting, or pain radiating into the groin and lower abdomen, along with the absence of the cremasteric reflex.
The Critical First Step: Immediate Medical Intervention
Testicular torsion is a condition where every minute counts, as the viability of the testicle is directly linked to the duration of the blood flow blockage. The most successful outcomes, where the testicle is saved, occur when treatment is initiated within four to six hours of the pain beginning. After 12 hours, the chance of saving the testicle drops significantly, and after 24 hours, the likelihood of permanent damage requiring removal is very high. The only appropriate and safe action for a patient experiencing these symptoms is immediate transport to an Emergency Room (ER) or calling emergency medical services. Attempts at self-diagnosis or trying to manually untwist the testicle at home are dangerous and waste precious time needed for professional intervention.
How Medical Professionals Untwist the Testicle
Medical professionals address testicular torsion using two primary methods: manual detorsion and surgical repair.
Manual Detorsion
Upon arrival at the emergency department, a urologist or trained physician may first attempt manual detorsion, which is a non-surgical maneuver to untwist the spermatic cord. This is performed by rotating the testicle outward, similar to opening a book, which is the correct direction in about half of the cases. If the manual attempt is successful, the patient may feel immediate relief from the pain, and blood flow can be assessed using a Doppler ultrasound. Even if manual detorsion appears successful, it is not a definitive solution and only serves as a temporizing measure to reduce ischemic damage.
Surgical Repair
Surgical exploration is necessary to ensure the cord is fully untwisted and to perform an orchiopexy, which is the definitive treatment for testicular torsion performed under general anesthesia. The surgeon makes a small incision in the scrotum to access the testicle, untwists the spermatic cord, and then assesses the testicle’s viability. If the testicle is viable, it is permanently anchored to the inside wall of the scrotum to prevent future twisting. This anchoring procedure is also performed on the opposite, unaffected testicle, as the anatomical predisposition for torsion (known as a “bell-clapper deformity”) is often present in both. If blood flow cannot be restored and the testicle tissue is irreversibly damaged, the surgeon must perform an orchiectomy, the surgical removal of the non-viable testicle.
Recovery and Preventing Recurrence
Following surgical repair, patients can expect a recovery period involving managing discomfort, swelling, and activity restrictions. Mild to moderate pain and swelling are normal for several days, managed with prescribed pain medication and ice packs, and most patients return home the same day or after a short overnight observation period. During the initial recovery phase (one to two weeks), patients must avoid strenuous activities such as heavy lifting or intense exercise to protect the surgical site. The orchiopexy procedure is highly effective in preventing future episodes of torsion. The long-term outlook depends heavily on whether the affected testicle was salvaged or required removal; however, the loss of one testicle typically does not affect the patient’s ability to achieve an erection or father children, as the remaining healthy testicle is usually sufficient for hormone and sperm production.