Testicular torsion

Symptoms and causes

What is it?

When a male foetus is in the mother's womb, the testicles develop in the baby's abdomen. As the foetus grows, these testicles gradually descend to the lower abdomen. They then ‘push’ themselves through a weak spot in the wall of the lower abdomen (the inguinal canal), in order to arrive at their destination, in the scrotum, around the time of birth. Logically, the blood supply to the testicle follows this route: this blood supply originates from the large abdominal blood vessels and follows the route through the inguinal canal to the scrotum.

When there is testicular torsion, the testicle rotates around its axis, restricting the blood supply to the testicle.

If the rotation of the testicle continues for a long time, there is a risk of the testicle dying off.

What are the symptoms in case a testicle rotates?

Acutely painful scrotum (typically on one side)
Severe pain radiating to the back and/or stomach
Nausea
Vomiting
Low fever

Diagnosis and treatment

How is the diagnosis determined?

Physical examination
Urine analysis
Ultrasound imaging in case of doubt as to the cause

Treatment

If the testicle is rotated, surgical treatment under anaesthesia is best performed within six hours. A small skin incision in the scrotum is performed to examine the testicle. The rotation is undone and the testicle is attached to the scrotum wall. Usually, the other testicle is also secured during the same anaesthesia. In rare cases, when the twisted testicle has died off, it is removed.

After this procedure, the scrotum is best supported for a few days with snugly fitting underpants. Sometimes, there is still a need for pain relief and ice application for a few days.