About testicular torsion

Testicular torsion (twisting) is a surgical emergency which is most common in teenagers and young adults. 

It occurs when the spermatic cord twists and cuts off the blood supply to the testicle.

If a testicle becomes twisted it can die within 6 hours without emergency surgery to restore blood flow.

Diagnosis and treatment

To begin diagnosing your condition, a doctor will ask you questions about your symptoms and examine you.

If they suspect you have testicular torsion, we will carry out an exploratory procedure. We do this while you are under general anaesthetic (asleep).  During this procedure, we make a small incision (cut) to explore the inside of the scrotum (the skin that surrounds the testicles).

During this procedure, if we discover that a testicle has twisted, we untwist it and use stitches to fix it and prevent it from twisting again in the future. 

If we find that the twisted testicle is not viable (we cannot save it), we remove it.

In both of these situations, we use stitches to fix the other testicle in the scrotum at the same time, so that remains viable and is less at risk of twisting.

Alternatives to surgical treatment

Surgical exploration is the only treatment for testicular torsion. 

During the procedure

We will not perform the procedure without your written consent. This includes consent to remove the testicle, if it cannot be salvaged, if we discover this is necessary during our exploration. It also includes consent to fix the other testicle.

You can expect the following on the day of your procedure.

  • A member of your surgical team will explain the procedure to you, and you will have a chance to ask questions. 
  • They will review your medical history, and ask about any medicines that you currently take or allergies that you may have. 
  • They will discuss pain relief for you to use following the procedure.
  • They may give you an injection of antibiotics before the procedure.
  • The surgeon will make either a single incision (cut) in the centre of your scrotum, or small incisions on each side.
  • If we confirm that your testicle has twisted, we will untwist it. If the affected testicle is still healthy and viable after untwisting, we will fix it in the scrotum with stitches to prevent further twisting.
  • We will also fix the other testicle to prevent it twisting in the future.  We will use stitches that absorb into your skin and disappear in 2 to 3 weeks.
  • Sometimes the testicle is severely damaged (a ‘dead testicle’) and we may need to remove it. This affects between 10% and 50% of patients.
  • Sometimes we find that it is not the testicle itself that has twisted, but a small attachment on the testicle or epididymis (a narrow tube attached to each testicle where sperm mature). In this situation, we will remove the twisted appendage.

The procedure usually takes about 1 hour.

Most people can go home the same day, or the day after surgery.

After the procedure

You can expect the following after the procedure.

  • You may feel a bit drowsy for a day or two as the anaesthetic wears off.
  • You also may experience some discomfort in your groin and scrotum for 7 to 10 days after surgery.
  • You can manage this discomfort with simple painkillers such as paracetamol and ibuprofen. 

Benefits and risks

Benefits

The benefits of the procedure include the following.

  • Confirmation of the diagnosis.
  • Salvaging (saving) the affected testicle.
  • Preserving fertility.
  • Stopping the pain.
  • Reducing the risk of it happening again.  This is because we fix both testicles during the procedure, not just the affected one.

Risks

Potential risks include the following.

  • Swelling and bruising of the scrotum which usually lasts a few days (affects up to 50% of patients).
  • Being able to feel the stitches through the scrotal skin (affects up to 10% of patients).
  • Development of a haematoma (blood clot) around the testicle which may take time to resolve or need surgical drainage (affects up to 10% of patients). See important information box below.
  • Infection in the wound requiring antibiotics or surgical drainage (affects up to 10% of patients).
  • Late atrophy (shrinkage) of the testicle.  
  • Reduced fertility caused by temporary interruption of the testicle's blood supply (affects up to 2% of patients). 
  • Anaesthetic or cardiovascular problems possibly requiring intensive care. These are rare and affect fewer than 1 in 250 patients.

Important information

When to seek urgent medical help
A&E icon.jpg
Go to your nearest emergency department (A&E) if you notice the following signs which can indicate a haematoma (blood clot) around the testicle:

  • localised pain or tenderness
  • localised swelling or a mass or lump that you can feel
  • warmth
  • discolouration.

In this situation, we may need to offer you surgical drainage of the testicle, due to the size of the swelling or risk of infection.

Recovery and follow-up

Recovery at home

When we discharge you home, you can expect some swelling and bruising of the scrotum which may last several days.

Over-the-counter painkillers will help to reduce any pain that you experience.

We advise you to wear supportive underwear after the procedure.

Important

Avoid heavy lifting and strenuous exercise for the first few weeks after the procedure.

Your doctor will advise you on returning to everyday activities.

Follow-up

We will arrange a follow-up appointment for you at Kingston Hospital, approximately 6 to 8 weeks after the procedure.

If you experience atrophy (shrinkage) of a testicle, your GP can advise on mental health counselling and support. They can also refer you to the Kingston Hospital Urology department for advice on getting a prosthesis (an artificial testicle).