Testicular torsion

Your doctor will ask you questions to verify whether your signs and symptoms are caused by testicular torsion or something else. Doctors often diagnose testicular torsion with a physical exam of the scrotum, testicles, abdomen and groin.

Your doctor might also test your reflexes by lightly rubbing or pinching the inside of your thigh on the affected side. Normally, this causes the testicle to contract. This reflex might not occur if you have testicular torsion.

Sometimes medical tests are necessary to confirm a diagnosis or to help identify another cause for your symptoms. For example:

• Urine test. This test is used to check for infection.
• Scrotal ultrasound. This type of ultrasound is used to check blood flow. Decreased blood flow to the testicle is a sign of testicular torsion. But ultrasound doesn't always detect the reduced blood flow, so the test might not rule out testicular torsion.
• Surgery. Surgery might be necessary to determine whether your symptoms are caused by testicular torsion or another condition.

If you've had pain for several hours and your physical exam suggests testicular torsion, you might be taken directly to surgery without any additional testing. Delaying surgery might result in loss of the testicle.

Surgery is required to correct testicular torsion. In some instances, the doctor might be able to untwist the testicle by pushing on the scrotum (manual detorsion). But you'll still need surgery to prevent torsion from occurring again.

Surgery for testicular torsion is usually done under general anesthesia. During surgery, your doctor will make a small cut in your scrotum, untwist your spermatic cord, if necessary, and stitch one or both testicles to the inside of the scrotum.

The sooner the testicle is untwisted, the greater the chance it can be saved. After six hours from the start of pain, the chances of needing testicle removal are greatly increased. If treatment is delayed more than 12 hours from the start of pain, there is at least a 75 percent chance of needing testicle removal.

Testicular torsion in newborns and infants

Testicular torsion can occur in newborns and infants, though it's rare. The infant's testicle might be hard, swollen or a darker color. Ultrasound might not detect reduced blood flow to the infant's scrotum, so surgery might be needed to confirm testicular torsion.

Treatment for testicular torsion in infants is controversial. If a boy is born with signs and symptoms of testicular torsion, it might be too late for emergency surgery to help and there are risks associated with general anesthesia. But emergency surgery can sometimes save all or part of the testicle and can prevent torsion in the other testicle. Treating testicular torsion in infants might prevent future problems with male hormone production and fertility.

Testicular torsion will likely occur as an emergency, leaving you little time to prepare. You'll probably first be seen in the emergency room or by your family doctor. However, you'll probably then be seen by a doctor who specializes in urinary tract problems and disorders affecting male genitals (urologist).

If you have some advance warning before you see the urologist, here's some information to help you prepare, and what to expect from your doctor.

What you can do

• Write down any symptoms you're experiencing, including any that might seem unrelated to the reason why you're seeking treatment.
• Write down questions to ask your doctor.

Don't hesitate to ask questions during your appointment. Some questions to ask your doctor include:

• Why did this happen?
• Are there other possible causes for my symptoms?
• What happens if I don't have surgery?
• What are the possible complications of surgery?
• Are there any restrictions on activity that I'll need to follow after surgery?
• How long after surgery will I have to wait to be sexually active?
• Will I be able to father children?
• How can I prevent this from happening again?

What to expect from your doctor

Your doctor is likely to ask you a number of questions. Being ready to answer them might give you more time to go over your concerns. You might be asked:

• When did you first begin experiencing symptoms?
• What were you doing when you first started experiencing symptoms?
• Have your symptoms been continuous, or did they go away for a time?
• How severe are your symptoms?
• Does anything seem to improve or worsen your symptoms?
• Has anyone in your family ever had testicular torsion?
• Has this ever happened to you before?