About testicular torsion

Testicular torsion (twisting) is a urological emergency which is most common in teenagers and young adults. Urological means related to the urinary and reproductive organs.

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 diagnose testicular torsion, we carry out an exploratory procedure. We usually 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. We also use stitches to fix the other testicle in the scrotum, so that it cannot twist in the future.

If we find that the twisted testicle is not viable (we cannot save it), we remove it. If this happens, we use stitches to fix the other testicle in the scrotum, so that remains viable.

Alternatives to treatment

Surgical exploration is currently the most accurate way of diagnosing testicular torsion. 

We sometimes use scanning to confirm a different diagnosis (such as an infection).

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.

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

  • A member of your urology 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. 
  • We may give you a pair of compression stockings to wear. These help to prevent the risk of a blood clot forming and passing into your lungs.
  • Your medical team will advise whether you will need to continue with these when you go home after the procedure.

Benefits and risks

Benefits

The benefits of the procedure include the following.

  • Salvaging (saving) the affected testicle.
  • Preserving fertility.
  • Reducing or stopping discomfort and 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).
  • Infection in the wound requiring antibiotics or surgical drainage (affects up to 10% of patients).
  • Late atrophy (shrinkage) of the testicle (affects up to 2% of patients).  
  • Reduced fertility due to testicular damage caused by temporary interruption of its blood supply (affects up to 2% of patients). 
  • Anaesthetic or cardiovascular problems possibly requiring intensive care (including chest infection, pulmonary embolus, stroke, deep vein thrombosis, heart attack and death). These are rare and affect fewer than 1 in 250 patients.

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.

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).

When to seek further medical help

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Make a GP appointment if testicular or scrotal pain occurs more than twice and corrects itself.