This document provides information about testicular torsion, including: - Testicular torsion occurs when the testicle twists around the spermatic cord, cutting off blood flow and requiring emergency surgery to untwist within 6 hours to save the testicle. - It is most common in males under 25 and can be caused by an unattached "bell clapper" deformity allowing the testicle to twist easily. - Symptoms include sudden severe pain in one testicle. Diagnosis involves physical exam and sometimes ultrasound, and treatment is always surgery to untwist and add sutures to prevent future twisting.

1. DEPARTMENT OF UROLOGY EDUCATION
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Testicular Torsion

2. What is Testicular Torsion ?
 Sometimes, the tissue surrounding a testicle is not well attached to the
scrotum. As a result, the testicle may become twisted around the
spermatic cord resulting in the blood supply being cut off.
 It is important to emphasize that testicular torsion is an Emergency. The
testicle will die and diminish in size if the blood supply is not restored
within approximately six hours. Restoration of the blood supply requires
untwisting the cord.
 Torsion is relatively rare, occurring in approximately one in 4,000 males
under the age of 25. However, it can also occur in newborns and in older
men

3. Anatomy of the Male Reproductive
System

4. What Causes Testicular Torsion?
 In most individuals a testicle cannot twist because the
surrounding tissue is well attached to the scrotum.
 The term "bell clapper" deformity is often used to describe a
congenital condition in those individuals, whose testes hang
within the scrotum and can "swing" like a bell clapper in a bell,
allowing for easy twisting.
 It must be emphasized that boys and men born with the "bell
clapper" deformity have no attachments around either testicle,
so that torsion can potentially occur on either side. Bilateral
testicular torsion, however, is an exceedingly rare event.

5. What are the symptoms of Testicular
Torsion ?
 The hallmark of testicular torsion is sudden, severe,
one-sided testicular pain. Torsion can occur at any
time, while sitting or standing, or may awaken an
individual from sleep.
 It also may occur during sports or physical exercise.
The left testis tends to be more commonly
affected. Torsion in undescended testes is also
more common on the left side in newborns.

6. How is Testicular Torsion Diagnosed ?
 The Clinical evaluation by the urologist, consisting of medical
history and physical examination, is often sufficient to
diagnose torsion.
 If the urologist cannot exclude torsion or suspects it, surgical
intervention must be undertaken without further delay.
 Both ultrasound and nuclear medicine techniques can be
used to assess blood flow to the testicle, and therefore, can
also exclude or confirm torsion.

7. How is Testicular Torsion treated ?
 All individuals with torsion require surgery.
 During surgery, the affected testicle will be
untwisted to see if blood flow is restored.
 Once the viability of the testes is confirmed
sutures are placed to prevent future torsion.
The other side has also to be fixed as the
rendency to twist can be present on the
opposite side.

8. How is Testicular Torsion treated ?
 Unfortunately, there are individuals whose testicles
cannot be saved, because it has already infarcted or
died. These individuals will undergo removal of the
affected testicle at the time of surgery and then
placement of sutures around the remaining opposite
testicle to prevent future torsion.
 The testicles of newborns with torsion can rarely be
salvaged by untwisting, because they are almost
always infarcted.

9. Important Information
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