Testicular torsion: What are the symptoms of this medical emergency?

Testicular torsion is a painful condition that occurs when the testicle twists on itself. This has the potential to cut off the blood supply to the testicle, resulting in a medical emergency. If left untreated, the testicle will eventually die due to lack of blood flow. This can happen in as little as six hours. Therefore, it’s important for parents and other caregivers to make sure that the condition is detected and treated by a medical professional as soon as possible to save the testicle. EIRMC’s Pediatric ER, staffed with pediatric emergency specialists, is well-equipped to treat this serious condition.  

The causes of testicular torsion and who is at risk

Testicular torsion affects about 1 in 4,000 males under the age of 25, but it can be present at birth and occur at any age. Typically, however, it happens at two main ages, according to Joseph Moore, MD, a pediatrician with EIRMC.

• During the neonatal period — shortly after birth
• More commonly, between the ages of 12 and 18

“During activity or movement, if the testicle isn’t attached to the side of the scrotum like it should be, the testicle can twist and cause an abrupt onset of testicular pain,” says Dr. Moore.

Testicular torsion symptoms

Pain and swelling are hallmark symptoms of testicular torsion. Sudden, severe pain on one side of the scrotum (the pouch that holds the testes) is the most common sign.

“The testicle will swell and become very tender,” Dr. Moore says. “That pain can also radiate up into the abdomen.”

Additional signs of testicular torsion may include:

• One testicle (more commonly the left) quickly becomes larger than the other
  • Testicular torsion in both testicles is rare and occurs in only about 2 out of 100 males
• Changes in scrotum color, especially redness or darkening
• A visible lump on the affected testicle
• Nausea and vomiting
• More frequent urination
• Fever

Less commonly, slow-onset pain in a testicle, over many hours or days, can be a sign of torsion.

Treatment for testicular torsion

As with any health emergency, Dr. Moore says time is of the essence with a torsion.

While the testicle can be untwisted in the ER, all testicular torsion patients will need surgery — ideally with a urologist — to prevent future twisting. The American Urological Association reported on a study showing that nearly 3 out of 4 patients need to have the testicle removed if surgery is not done within 12 hours.

“Because the blood supply is cut off to the testicle, if it doesn’t get restored they could actually lose the testicle,” Dr. Moore emphasizes. “If you’re able to get in, get diagnosed and get the torsion surgically corrected within the first four to six hours, there is a more than 90 percent chance that the testicle can be saved.”

“If you’re concerned about testicular torsion or have any question that it could be happening, you want to get that checked out right away,” says Dr. Moore.

EIRMC offers experienced and competent emergency care, including the region’s only Pediatric ER, as well as specialized pediatric urology surgery.