Written by Soraya Sritangos
Last Reviewed: August 2019
Review Due: August 2020
‘twisting of the testis on the spermatic cord resulting in compromisation of blood supply to the ipsilateral testis. It is a urological emergency requiring early diagnosis and treatment to preserve testis viability and fertility’
The most common anatomical defect which predisposes to testicular torsion
SIGNS AND SYMPTOMS1,2
Classic presentation: acute severe unilateral scrotal pain and scrotal swelling.
Absence of cremasteric reflex
Abnormal testicular lie- High-riding and/or horizontal lie
Elevation of scrotum does not relieve pain
History of trauma/physical activity
History of previous episode(s)- recurrent self-limiting (spontaneous torsion and detorsion)
Other features include:
Scrotal erythema and oedema
Nausea and vomiting
**Suspect testicular torsion in all males ( <30 years old) with acute scrotal pain and swelling**
Intravaginal Torsion: most common, twisting of the spermatic cord and the blood supply to the testis within the tunica vaginalis, resulting in venous occlusion, ischemia and infarction of the testis of the affected side.
Bell Clapper deformity: a congenital defect where there is an abnormal attachment of the tunica vaginalis to the testis, allowing the testis to rotate freely within the tunica vaginalis and can result in an abnormal horizontal-lie position of the testis within the scrotum, which predisposes to torsion. Bilateral torsion in 40% of cases.
Torsion can be partial or complete (⩾360°). The duration and degree of torsion influence the viability of the testis. Torsion more than 6 hours decreases the chance of testicular salvage, and if ⩾ 24 hours there is a high risk of testicular necrosis.
Extravaginal torsion: occurs in neonates, as the tunica vaginalis has not fully developed yet.
No useful laboratory tests
Urgent surgical exploration is required
Doppler Ultrasound scan - lack of blood flow to testis, only if diagnostic uncertainty. Surgery should not be delayed for ultrasound
Emergency Surgical Detorsion (within 4 - 8 hours of onset) + bilateral scrotal orchidopexy - definitive treatment
± Orchidectomy - if unsalvageable
Manual Detorsion- may be attempted but often difficult due to pain; not a substitute for surgical exploration.
Success detorsion is confirmed by Doppler Ultrasound and complete resolution of symptoms
+ bilateral scrotal orchidopexy
Primarily a paediatric condition. Most commonly affects adolescents aged 12 -18, but can affect men of any age.
Left testis is more commonly affected, rarely bilateral.
Testicular salvageability is dependent on time between onset of symptoms and detorsion:
< 6 hours : 90 - 100% salvageability
> 12 hours: < 50%
> 24 hours: < 10%
Kaplan G. Testicular Torsion BMJ Best Practice 2018
Ogunyem, O. Testicular Torsion. Medscape 2018
Scrotal Pain and Swelling. NICE Clinical Knowledge Summary 2019