Testicular Torsion
Basics
Description
- Twisting of testis and spermatic cord, resulting in acute ischemia and loss of testis if unrecognized:
- Intravaginal torsion: occurs within tunica vaginalis, only involves testis and spermatic cord. Most commonly seen in practice.
- Extravaginal torsion: involves twisting of testis, cord, and processus vaginalis as a unit; typically seen in neonates
- System(s) affected: reproductive
Geriatric Considerations
Rare in this age group
Pediatric Considerations
Peak incidence at age 14 years
Epidemiology
Incidence
- ~1/4,000 males before age 25 years
- Predominant age:
- Occurs from newborn period to 7th decade
- 65% of cases occur in 2nd decade, with peak at age 14 years; rare beyond the age of 30 years
- Second peak in neonates (in utero torsion usually occurs around week 32 of gestation)
Etiology and Pathophysiology
- Initial incomplete twisting of spermatic cord causes venous obstruction and edema of testis, leading to congestion and then to ischemia.
- Complete twisting of the spermatic cord causes arterial occlusion, in addition to the above, leading to rapid ischemia.
- Congenital bell clapper deformity, which is bilateral in at least 2/5th of cases: A high mesorchium (the posterolateral attachment of the testis to the tunica vaginalis) allows more room for the testis to twist within the tunica vaginalis and is associated intravaginal testicular torsion.
- No clear anatomic defect is associated with extravaginal testicular torsion:
- In neonates, the tunica vaginalis is not yet well attached to scrotal wall, allowing torsion of entire testis including tunica vaginalis.
- Usually spontaneous and idiopathic
- 20% of patients have a history of trauma.
- 1/3 have had prior episodic testicular pain.
- Contraction of cremaster muscle or dartos may play a role and is stimulated by trauma, exercise, cold, and sexual stimulation.
- Increased incidence may be due to increasing weight and size of testis during pubertal development.
- Possible alterations in testosterone levels during nocturnal sex response cycle; possible elevated testosterone levels in neonates
- Testis must have inadequate, incomplete, or absent fixation within scrotum.
- Torsion may occur in either clockwise or counterclockwise direction.
Genetics
- Unknown
- Familial testicular torsion, although previously rarely reported, may involve as many as 10% of patients.
Risk Factors
- May be more common in colder months
- Paraplegia
- Previous contralateral testicular torsion
There's more to see -- the rest of this topic is available only to subscribers.
Citation
Domino, Frank J., et al., editors. "Testicular Torsion." 5-Minute Clinical Consult, 33rd ed., Wolters Kluwer, 2025. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116592/1.2/Testicular_Torsion.
Testicular Torsion. In: Domino FJF, Baldor RAR, Golding JJ, et al, eds. 5-Minute Clinical Consult. Wolters Kluwer; 2025. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116592/1.2/Testicular_Torsion. Accessed October 13, 2024.
Testicular Torsion. (2025). In Domino, F. J., Baldor, R. A., Golding, J., & Stephens, M. B. (Eds.), 5-Minute Clinical Consult (33rd ed.). Wolters Kluwer. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116592/1.2/Testicular_Torsion
Testicular Torsion [Internet]. In: Domino FJF, Baldor RAR, Golding JJ, Stephens MBM, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2025. [cited 2024 October 13]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116592/1.2/Testicular_Torsion.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC
T1 - Testicular Torsion
ID - 116592
ED - Domino,Frank J,
ED - Baldor,Robert A,
ED - Golding,Jeremy,
ED - Stephens,Mark B,
BT - 5-Minute Clinical Consult, Updating
UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116592/1.2/Testicular_Torsion
PB - Wolters Kluwer
ET - 33
DB - Medicine Central
DP - Unbound Medicine
ER -