Testicular torsion: an emergency that cannot wait

Testicular torsion occurs when the testicle rotates on its own axis, cutting off blood flow. It is a true surgical emergency because the testicle can be lost if not operated on in time. Every minute counts.

Who does it affect?

It can occur at any age, but has two peak frequencies:

• Newborns (neonatal torsion)
• Adolescents between 12 and 18 years (the most common peak)

Symptoms: how to recognize it?

The presentation is typical and should generate immediate alarm:

• Sudden, intense testicular pain — appears abruptly, often during sleep
• Scrotal swelling — the affected side swells and reddens
• Nausea and vomiting — due to the intensity of the pain
• The testicle is higher than normal
• Rest does not relieve — the pain does not improve, it worsens

Why is it an emergency?

The testicle needs constant blood flow. When it twists:

• Before 6 hours: probability of saving the testicle greater than 90%
• Between 6 and 12 hours: the probability drops significantly
• After 24 hours: loss of the testicle is almost certain

Do not wait to see if it improves. Go to the emergency room immediately.

How is it treated?

Surgery (scrotal exploration) is the definitive treatment:

• The testicle is untwisted and its viability is assessed
• The testicle is fixed to the scrotum to prevent future torsion
• The testicle on the opposite side is also fixed (prevention)
• Surgery takes approximately 30-45 minutes
• Recovery is 1-2 weeks

What NOT to do?

• Do not wait for the pain to pass
• Do not confuse with a blow or "normal" pain
• Do not apply ice or home remedies
• Do not self-medicate — go to the emergency room directly

Difference from other causes

Not all testicular pain is torsion, but all acute testicular pain deserves urgent evaluation. Other causes include:

• Hydatid torsion (less serious, but similar)
• Epididymitis (infection, more gradual)
• Incarcerated inguinal hernia

Only a doctor can differentiate them. When in doubt, it is always better to go to the emergency room.