What Is Testicular Torsion?

Testicular torsion is a urological emergency characterized by twisting of the spermatic cord, which cuts off blood flow to the testicle. This condition most commonly occurs in adolescent males, particularly between the ages of 12 and 18, but can also affect newborns and adults. The twisting—often occurring in a counterclockwise direction—compromises arterial inflow and venous outflow, leading rapidly to ischemia, edema, and, if untreated, infarction of testicular tissue.

Symptoms typically present acutely and include sudden, severe scrotal pain, often radiating to the lower abdomen or groin; swelling and erythema of the affected hemiscrotum; elevation and rotation of the testicle (with the long axis oriented horizontally rather than vertically); and absence of the cremasteric reflex on the involved side. Nausea and vomiting are common due to shared autonomic innervation with the gastrointestinal tract.

Diagnosis relies primarily on clinical assessment, though Doppler ultrasonography is used to confirm reduced or absent intratesticular blood flow when physical findings are equivocal. Prompt recognition is critical: salvage rates exceed 90% if surgical detorsion occurs within six hours of symptom onset, but decline sharply thereafter—dropping to less than 10% after 24 hours.

Management requires immediate surgical exploration and detorsion, followed by bilateral orchiopexy to prevent recurrence. Manual detorsion may be attempted as a temporizing measure—typically involving external rotation of the testicle away from the midline (i.e., “opening a book” maneuver)—but definitive treatment remains operative intervention. Delayed diagnosis or misdiagnosis—often confused with epididymitis or orchitis—carries significant risk of testicular loss and potential long-term implications for fertility and hormonal function.