Testicular torsion

Testicular torsion occurs when there is a twist of the spermatic cord (the cord that runs between the testicles and openings at the level of the bladder, containing blood vessels, sperm tube and nerves). This twist blocks blood flow to the testicles, which can cause irreparable damage to the testicle if not treated within a few hours.

Testicular torsion is a surgical emergency. The health of the testis can decline significantly from six hours after the onset of symptoms.

What causes testicular torsion?

Congenital factors

Some boys are more likely to experience testicular torsion due to abnormally loose attachments of the testis within the scrotum. This is known as a ‘bell clapper’ deformity and accounts for 90 per cent of testicular torsion cases. There is no definite way of detecting a bell clapper deformity beforehand. Testicular torsion may also run in families.

Other causes

Testicular torsion can occur at any time – e.g. while sleeping, sitting on the couch, or after activity and trauma. Rapid growth of the testicles during puberty is also a risk factor.

Who is at risk of testicular torsion?

Most cases are between the ages of 12 and 18, but testicular torsion can occur at any age.

Signs and symptoms

The following symptoms can indicate testicular torsion:

• pain in the testicles and/or the lower abdomen on the same side
• nausea
• vomiting
• dizziness.

The following signs can indicate your child has testicular torsion:

• tenderness or swelling of the testis
• a testicle that sits higher within the scrotum, or one that lies crossways rather than vertically
• redness and swelling of the scrotal skin
• discomfort when walking or sitting.

If your child is experiencing pain in the testicles or lower abdomen, take them immediately to your closest emergency department.

How is testicular torsion diagnosed?

Testicular torsion is diagnosed by the identification of common symptoms, and an examination of the scrotum. An ultrasound is not commonly required in children, and often only delays treatment.

Don’t be afraid to ask your doctor if your child’s pain/symptoms could be testicular torsion. Stomach pain can be related to the testicles. Testicular examinations may be awkward or embarrassing, but they are necessary.

How is testicular torsion treated?

The only treatment is an urgent operation. The twisted testicle loses blood supply within a few hours – the longer it is without blood, the higher the chance the testicle may die and need to be removed.

During the operation, the testicle is untwisted and stitched in place to prevent it happening again. This is a 30-minute operation under general anaesthesia, and the patient can usually go home within 24 hours.

What is the recovery like?

There is a wound on the scrotum and bruising/swelling is expected for one to two weeks. Bathing can resume 24 to 48 hours after the operation and patients can go back to school within one or two weeks. Sport can be resumed in two to three weeks.

Dissolvable stitches are usually used so there is no need for removal. Dressings vary depending on the treating team.

Your child’s treating team will provide you with information to help with healing and recovery.

What if it’s too late?

If a testicle can’t be saved, it will need to be removed. The other testicle will be stitched in place to prevent it also twisting.

There are options for prosthetic testicles, but these are not routinely inserted during the first operation.

It is still possible to have children with one testicle.

When to get help

Call Triple Zero (000) in an emergency and ask for an ambulance.

If you think your child has signs or symptoms of testicular torsion, go to your nearest emergency department immediately.

If you're not sure whether to go to an emergency department, call 13 HEALTH (13 43 25 84) and speak to a registered nurse.

Developed by QCH Emergency and Paediatric Surgery departments, along with the Queensland Paediatric Quality Council. We acknowledge the input of consumers and carers.

Resource ID: FS341. Reviewed: March 2019.

Disclaimer: This information has been produced by healthcare professionals as a guideline only and is intended to support, not replace, discussion with your child’s doctor or healthcare professionals. Information is updated regularly, so please check you are referring to the most recent version. Seek medical advice, as appropriate, for concerns regarding your child’s health.