What is testicular torsion?
The testicle hangs from the spermatic cord. The artery and veins that supply the testicle run through this cord. In some children the testicle is not attached firmly enough in the scrotum, so it can rotate around its own axis. When the cord twists, blood flow stops. This is called testicular torsion.
It is the most urgent condition in pediatric urology. If blood flow is not restored, the testicle starts to die within a few hours.
Who gets it?
- most often adolescents aged 12–18, especially during sleep or after sports,
- newborns (sometimes even before birth),
- the risk is higher in an undescended testicle.
Signs
- sudden, severe testicular pain, usually on one side,
- the pain may spread to the groin and lower abdomen,
- nausea and vomiting,
- the testicle swells, turns red, rides high, and sometimes lies horizontally,
- because they are embarrassed, adolescents sometimes complain only of “stomach pain”.
Why does time matter?
| Time since pain started | Chance of saving the testicle |
|---|---|
| Up to 6 hours | 90–100% |
| 12 hours | about 50% |
| More than 24 hours | less than 10% |
That is why with sudden testicular pain you must not wait at home or give a painkiller and wait until morning.
Diagnosis
The diagnosis is made mainly by examination. Doppler ultrasound shows blood flow in the testicle and is useful, but when suspicion is high, surgery goes ahead without losing time on an ultrasound.
Similar signs also occur with torsion of the appendix testis and epididymitis. Telling these apart is the doctor’s job, which is why every case of sudden testicular pain needs urgent care.
Treatment
Emergency surgery: the scrotum is opened, the twist in the spermatic cord is undone, and the color and blood flow of the testicle are assessed.
- If the testicle is alive, it is stitched into the scrotum (orchiopexy).
- If the testicle has died, it is removed.
- In both cases the other testicle is also stitched in place, because the same anatomical tendency is often present on both sides.
Torsion of the appendix testis
At the upper pole of the testicle there is a small remnant tissue (the hydatid). Its torsion is the most common cause of acute testicular pain in children aged 7–12. The pain usually starts more slowly, and sometimes a bluish dot is visible through the skin above the testicle. This condition goes away without surgery, with rest and painkillers, within a few days. But an examination is essential to tell it apart from testicular torsion.
When to seek urgent care
If any of the following is present, do not wait for a routine appointment: call the doctor or go to the nearest emergency department.
- Sudden, severe pain in the testicle, especially pain that wakes him from sleep
- Nausea and vomiting together with the pain
- The testicle riding high, swollen, red
- Unexplained pain in the lower abdomen or groin in an adolescent boy (check the testicle too)
- A hard, bluish, swollen scrotum in a newborn
Note for pediatricians and family doctors
In an acute scrotum, urgent urological consultation is needed until torsion is ruled out. Doppler ultrasound should not delay surgery when clinical suspicion is high; a normal Doppler does not fully rule out torsion. The TWIST score is useful for triage. The time elapsed since pain onset is the main factor determining the chance of testicular salvage. In adolescents presenting with abdominal pain, the scrotum must be examined.
What happens at the visit?
- A child with suspected torsion is examined without waiting, and Doppler ultrasound is done when needed.
- If suspicion is high, the child is taken to surgery without waiting for an ultrasound.
- In surgery the twist is undone; if blood flow returns, both that testicle and the other one are fixed in the scrotum to prevent another twist.
Frequently asked questions
The pain went away. Do we still need to see a doctor?
Yes. Sometimes the testicle twists and untwists on its own and the pain goes away. This can happen again and is prevented with planned surgery.
After surgery, will my son be able to become a father?
If the testicle was saved, usually yes. Even if the testicle is lost, one healthy remaining testicle produces enough hormones and sperm.
Related topics
Sources
- EAU Guidelines on Paediatric Urology, 2025: Acute scrotum.
- Barbosa JA et al. Development and initial validation of a scoring system to diagnose testicular torsion in children (TWIST). J Urol, 2013.
This page is for education. Decisions about your child’s treatment are made together with the doctor after an examination.