The testicles are each supplied with blood via a spermatic cord, which surrounds the relevant blood vessels, nerves and muscles as they pass out of the abdominal cavity and down into the scrotum. If the testicle becomes twisted on its spermatic cord, the blood vessels are compressed and the testicle loses blood supply. This causes intense testicular and/or abdominal pain, often followed by light-headedness, nausea and even vomiting. Urgent surgery within 4–6 hours is usually required to save the testicle. The problem is most common towards the beginning of puberty, and so any young boy with testicular pain ought to see a doctor as a matter of some urgency.

What Causes it?

Testicular torsion sometimes occurs following injury to the testes or as a result of strenuous activity. Cold weather is also blamed, as the movement from warm to cold environs causes the scrotum to contract around the testicle, potentially trapping a slightly-twisted testicle. In most cases, it is an abnormality in the development of the testes that allows them sufficient mobility to become twisted. During normal development, the back of the testicle becomes stuck to the inner lining of the scrotum; however, in the so-called 'bell-clapper deformity', the testicle hangs free inside the scrotum, making it more likely to twist on its cord.

Diagnosis and Treatment

Suspecting torsion is important, as the diagnosis is based mainly on the sudden onset of testicular pain. The presence of an 'exquisitely' painful, high-riding testicle would be typical in testicular torsion, but there are large enough grey areas that doubt as to the diagnosis cannot be entertained. Swelling of the testes is more common in mumps¹ or epididymitis², and adults are less likely to have the condition, but if there is reason to suspect torsion then surgery becomes mandatory. Scanning of the testicular blood vessels using an ultrasound probe to look at blood flow is sometimes used to rule out an unlikely case of torsion, but surgery remains the only way to be absolutely sure, and is generally regarded as best practice.

Surgery involves examination of the scrotal contents under anaesthetic, with the torsion being corrected if the testicle is still alive. (If the testicle is dead, it must be removed to prevent infection.) Once the torsion has been corrected, the testicle is secured by sewing it to the scrotal inner wall behind it. This is known as orchidopexy, and is often done for the normal testicle as well as the torted one, so as to prevent future problems.

Summary

Testicular torsion is due to sudden twisting of the testicle, resulting in a lack of blood supply, severe pain, and the need for urgent surgery to save the testicle.

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