Testicular torsion occurs when the spermatic cord, which supplies blood to the testicle, twists and cuts off the blood supply. Symptoms of this include:

• Sudden, severe pain in testicles/scrotum
• Swelling, especially on one side of the scrotum
• Change to the position of the testicle – it may be sitting higher than usual in the scrotum and may be in a more horizontal position than usual
• Redness
• Abdominal pain
• Nausea and vomiting.

It can happen at any age but is most common between the ages of 10 and 25 years. Testicular torsion can happen spontaneously but it may occur after a trauma or injury to the testicle. It affects around 3.8 out of 100,000 males under 18 every year.

Testicular torsion that goes on for more than a few hours can permanently damage the testicle and so it is vital that it is suspected and investigated promptly. The scrotum, testicles, groin and abdomen should be examined and if identified, emergency surgery called scrotal exploration surgery will be required to untwist the testicle. Even if torsion is not confirmed but remains a possibility following assessment, surgery will take place as an emergency due to the risk to the testicle if torsion is left untreated.

It is estimated that a testicle can be successfully operated on up to around 6 hours after the pain becomes present and it is unlikely that there will be any long-term effects. After 12 hours, it is possible to save the testicle but the likelihood is reduced. After 24 hours, it is highly likely that the testicle will be permanently damages.

In the surgery a cut is made in the scrotum so that the testicle can be examined and untwisted; the untwisting is called orchidopexy. Both testicles will be ‘fixed’ in place with stitches to avoid it happening again. The testicle will also be observed for return of blood supply, essentially to check if the testicle has survived; if it has been deprived of blood supply for too long, the tissue will die and the testicle will no longer function.

If the testicle has not survived, it will need to be removed, which is called orchidectomy. The loss of a testicle can impact fertility (although the reduction in fertility is often minimal as a single remaining testicle can typically produce enough sperm and testosterone for normal function). As well as the physical impact of losing a testicle, it may also affect psychologically, including anxiety surrounding sexual function and fertility.

If there is negligent delay with diagnosis of testicular torsion, this can be result in a testicle not surviving that would otherwise have been able to be saved. It is a common condition to be missed in children upon attendance at A&E, often being misdiagnosed as an infection or a hydrocele (fluid in the scrotum).

If you or a loved one has suffered from testicular torsion and feel that there may have been a negligent delay in diagnosis which has caused a worse outcome, we can review your case. Please do not hesitate to contact us for advice or a consultation; we are ready to discuss your case and provide the support that you need.