{"id":2329,"date":"2021-02-19T08:00:00","date_gmt":"2021-02-19T01:00:00","guid":{"rendered":"https:\/\/drsoaraweeurology.com\/?p=2329"},"modified":"2026-08-29T04:35:12","modified_gmt":"2026-08-28T21:35:12","slug":"torsion-testiculaire-urologic-emer","status":"publish","type":"post","link":"https:\/\/drsoaraweeurology.com\/fr\/2021\/02\/19\/testicular-torsion-urologic-emer\/","title":{"rendered":"Testicular Torsion: Sudden Severe Pain in One Testicle Is an Emergency"},"content":{"rendered":"\n<div class=\"wp-block-columns coblocks-author-columns has-background is-layout-flex wp-container-core-columns-is-layout-52275889 wp-block-columns-is-layout-flex\" style=\"background-color:#8C8C971A;padding-top:2.5rem;padding-right:2.5rem;padding-bottom:2.5rem;padding-left:2.5rem\">\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\" style=\"flex-basis:25%\">\n<figure class=\"wp-block-image size-full is-style-rounded\"><img data-recalc-dims=\"1\" fetchpriority=\"high\" decoding=\"async\" width=\"800\" height=\"800\" data-attachment-id=\"7037\" data-permalink=\"https:\/\/drsoaraweeurology.com\/fr\/new-photo-2024\/\" data-orig-file=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2023\/12\/New-Photo-2024.png?fit=800%2C800&amp;ssl=1\" data-orig-size=\"800,800\" data-comments-opened=\"1\" data-image-title=\"Dr. Soarawee Weerasopone \u2014 Board-Certified Urologist in Bangkok, Thailand\" data-image-description=\"\" data-image-caption=\"&lt;p&gt;Dr. Soarawee Weerasopone \u2014 Board-Certified Urologist in Bangkok, Thailand&lt;\/p&gt;\n\" data-large-file=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2023\/12\/New-Photo-2024.png?fit=800%2C800&amp;ssl=1\" src=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2023\/12\/New-Photo-2024.png?resize=800%2C800&#038;ssl=1\" alt=\"Dr. Soarawee Weerasopone \u2014 Board-Certified Urologist in Bangkok, Thailand\" class=\"wp-image-7037\" 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aria-label=\"View Google Scholar Profile\"\n     style=\"text-decoration: none; color: #4285F4; transition: transform 0.2s; display: inline-block;\"\n     onmouseover=\"this.style.transform='scale(1.15)'\"\n     onmouseout=\"this.style.transform='scale(1)'\">\n    <svg width=\"28\" height=\"28\" viewBox=\"0 0 24 24\" fill=\"currentColor\">\n      <path d=\"M5.242 13.769L0.5 9.5 12 1l11.5 8.5-4.742 4.269C17.548 11.249 14.978 9.5 12 9.5c-2.977 0-5.548 1.748-6.758 4.269zM12 10a7 7 0 1 0 0 14 7 7 0 0 0 0-14z\"\/>\n    <\/svg>\n  <\/a>\n  \n<\/div>\n\n\n\n<h2 class=\"wp-block-heading\">If this is happening now<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Sudden severe pain in one testicle means going to an emergency department immediately \u2014 not in the morning, not after trying a painkiller.<\/strong> The testicle&#8217;s blood supply may be cut off, and what can be saved is decided in hours. In Thailand, call <strong>1669<\/strong>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Do not eat or drink on the way, in case an operation is needed straight away. Take someone with you \u2014 the pain is usually severe enough that driving is not sensible.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The rest of this page explains why the urgency is real, and three things that are commonly got wrong.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">What happens<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">The testicle hangs from the spermatic cord, which carries its blood supply. In torsion the testicle rotates on that cord, the vessels are twisted shut, and the tissue begins to die.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The reason it can happen at all is usually anatomical: in some men the testicle is not properly anchored within its covering and hangs free, able to rotate \u2014 the so-called bell clapper arrangement. <strong>Autopsy studies find it in roughly 5% to 16% of testes, and it is present on both sides in most of those men<\/strong>; the great majority never come to any harm. Among men who actually present with torsion, the same anatomy is found on the opposite side in most cases, which is why the other testicle is fixed during the same operation. A contraction of the muscle that lifts the scrotum, in response to cold or exercise or nothing in particular, is then enough to set it spinning.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">It is uncommon \u2014 of the order of <strong>one in four thousand males under 25 each year<\/strong> \u2014 and most frequent in adolescence, when it is thought that rapid growth and hormonal change make the lifting reflex more vigorous.<\/p>\n\n\n\n<figure class=\"wp-block-image aligncenter size-large\"><img decoding=\"async\" width=\"1200\" height=\"800\" data-attachment-id=\"2334\" data-permalink=\"https:\/\/drsoaraweeurology.com\/fr\/2021\/02\/19\/testicular-torsion-urologic-emer\/asian-guy-is-pro-feeling-proud-and-self-assured-triumphing-being-winner-pointing-at-himself-with-thumbs-tilting-head-looking-confident-and-assertive-in-own-skills-posing-in-glasses-and-white-t-shirt\/\" data-orig-file=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/02\/Adolescent.jpg?fit=1200%2C800&amp;ssl=1\" data-orig-size=\"1200,800\" data-comments-opened=\"1\" data-image-meta=\"{&quot;aperture&quot;:&quot;4.5&quot;,&quot;credit&quot;:&quot;Seva Levitsky&quot;,&quot;camera&quot;:&quot;Canon EOS 5D Mark III&quot;,&quot;caption&quot;:&quot;Asian guy is pro feeling proud and self-assured triumphing, being winner pointing at himself with thumbs tilting head looking confident and assertive in own skills, posing in glasses and white t-shirt.&quot;,&quot;created_timestamp&quot;:&quot;1522424250&quot;,&quot;copyright&quot;:&quot;Cookie Studio 2017&quot;,&quot;focal_length&quot;:&quot;70&quot;,&quot;iso&quot;:&quot;100&quot;,&quot;shutter_speed&quot;:&quot;0.00625&quot;,&quot;title&quot;:&quot;Asian guy is pro feeling proud and self-assured triumphing, being winner pointing at himself with thumbs tilting head looking confident and assertive in own skills, posing in glasses and white t-shirt&quot;,&quot;orientation&quot;:&quot;1&quot;}\" data-image-title=\"All evidence confirmed that Pre-puberty age has the most reported.\" data-image-description=\"\" data-image-caption=\"&lt;p&gt;All evidence confirmed that Pre-puberty age has the most reported.&lt;\/p&gt;\n\" data-large-file=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/02\/Adolescent.jpg?fit=800%2C534&amp;ssl=1\" src=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/02\/Adolescent.jpg?resize=800%2C533&amp;ssl=1\" alt=\"Teenage boy \u2014 adolescents are the age group most affected by testicular torsion\" class=\"wp-image-2334\" srcset=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/02\/Adolescent.jpg?w=1200&amp;ssl=1 1200w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/02\/Adolescent.jpg?resize=300%2C200&amp;ssl=1 300w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/02\/Adolescent.jpg?resize=1024%2C683&amp;ssl=1 1024w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/02\/Adolescent.jpg?resize=768%2C512&amp;ssl=1 768w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/02\/Adolescent.jpg?resize=16%2C12&amp;ssl=1 16w\" sizes=\"(max-width: 800px) 100vw, 800px\" \/><figcaption class=\"wp-element-caption\">Adolescence is the peak age \u2014 but torsion is not confined to it, which is where diagnoses get missed.<\/figcaption><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\">Three things that are commonly got wrong<\/h2>\n\n\n\n<h3 class=\"wp-block-heading\">1. A normal ultrasound does not rule it out<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">This is the most important addition to this article, and it was not in the earlier version.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Doppler ultrasound looks for blood flow, and it is useful \u2014 but it is not perfect. Flow can still be detected in a testicle that is twisted, particularly where the rotation is partial or the scan is done early, and the quality of the study depends heavily on who performs it. <strong>Torsion is a clinical diagnosis.<\/strong> Where the history and examination point to it, the right answer is to operate, not to wait for a scan or to be reassured by one.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">If you are told your scan was normal but the pain came on suddenly, is severe, and is not settling, <strong>say so and ask to be seen by a urologist before you are sent home.<\/strong> That request has saved testicles.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">2. It is frequently mistaken for an infection<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Epididymitis \u2014 inflammation of the tube behind the testicle \u2014 causes pain in the same place and is far commoner. The difference is usually in the story: infection builds over days, often with burning on passing urine or a fever, while <strong>torsion arrives abruptly, at full severity, frequently waking someone from sleep<\/strong>, and commonly brings nausea or vomiting.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The consequence of confusing them is being sent away with antibiotics while the testicle dies. Where there is genuine doubt, the safe course is to explore surgically rather than to observe. The infection side of that distinction is covered in <a href=\"https:\/\/drsoaraweeurology.com\/2020\/09\/25\/testicular-infection\/\">testicular infection<\/a>.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">3. It is not only a teenage condition<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Adolescence is the peak, but torsion occurs in newborn babies, and it occurs in men in their thirties, forties and beyond. Men outside the typical age band are more likely to be assumed to have an infection, and therefore more likely to be diagnosed late. <strong>Age is a probability, not a rule out.<\/strong><\/p>\n\n\n\n<figure class=\"wp-block-image aligncenter size-large\"><img decoding=\"async\" width=\"1200\" height=\"800\" data-attachment-id=\"2335\" data-permalink=\"https:\/\/drsoaraweeurology.com\/fr\/2021\/02\/19\/testicular-torsion-urologic-emer\/man-standing-and-bowing-on-hands-outdoors-in-cold-weather\/\" data-orig-file=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/02\/Cold-weather.jpg?fit=1200%2C800&amp;ssl=1\" data-orig-size=\"1200,800\" data-comments-opened=\"1\" data-image-meta=\"{&quot;aperture&quot;:&quot;4&quot;,&quot;camera&quot;:&quot;Canon EOS 5D Mark III&quot;,&quot;caption&quot;:&quot;Attractive bearded young man standing and bowing on his hands outdoors in cold weather&quot;,&quot;created_timestamp&quot;:&quot;1485778450&quot;,&quot;focal_length&quot;:&quot;120&quot;,&quot;iso&quot;:&quot;100&quot;,&quot;shutter_speed&quot;:&quot;0.002&quot;,&quot;title&quot;:&quot;Man standing and bowing on hands outdoors in cold weather&quot;,&quot;orientation&quot;:&quot;1&quot;}\" data-image-title=\"More testicular torsions are reported in cold weather climate.\" data-image-description=\"\" data-image-caption=\"&lt;p&gt;More testicular torsions are reported in cold weather climate.&lt;\/p&gt;\n\" data-large-file=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/02\/Cold-weather.jpg?fit=800%2C534&amp;ssl=1\" src=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/02\/Cold-weather.jpg?resize=800%2C533&amp;ssl=1\" alt=\"Cold winter scene \u2014 observational studies from several countries report more testicular torsion during colder months\" class=\"wp-image-2335\" srcset=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/02\/Cold-weather.jpg?w=1200&amp;ssl=1 1200w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/02\/Cold-weather.jpg?resize=300%2C200&amp;ssl=1 300w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/02\/Cold-weather.jpg?resize=1024%2C683&amp;ssl=1 1024w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/02\/Cold-weather.jpg?resize=768%2C512&amp;ssl=1 768w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/02\/Cold-weather.jpg?resize=16%2C12&amp;ssl=1 16w\" sizes=\"(max-width: 800px) 100vw, 800px\" \/><figcaption class=\"wp-element-caption\">Studies from Scotland, Taiwan and Israel each report more cases in colder months \u2014 a consistent observation, though the mechanism is unproven.<\/figcaption><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\">On that last point: the cold-weather pattern is better supported than it might sound. A 25-year Scottish study found torsion rates rose as ambient temperature fell, a 10-year nationwide Taiwanese study found a January peak with the same inverse relationship, and an Israeli series reported roughly three times the odds at low temperatures. These are population-level observations rather than proof of a mechanism, and the practical implication is small \u2014 but it is a real and repeated finding, not folklore.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">The warning episodes that come first<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Some men describe repeated attacks of sudden severe testicular pain that last minutes to an hour and then settle completely, sometimes over months or years. That is <a href=\"https:\/\/drsoaraweeurology.com\/2022\/04\/01\/intermittent-testicular-torsion\/\">intermittent torsion<\/a> \u2014 the testicle twisting and untwisting on its own \u2014 and it identifies someone whose anatomy will eventually catch him out.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>These episodes are worth acting on precisely because they resolve.<\/strong> The testicles can be fixed to the scrotal wall as a planned operation, in daylight, with no clock running. Men who mention this pattern only after losing a testicle are among the most frustrating cases in urology, because the opportunity was there and nobody knew to ask.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">The operation, and the clock<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">The scrotum is opened, the cord is untwisted, and the testicle is watched to see whether its colour returns. If it recovers it is stitched to the scrotal wall so it cannot rotate again \u2014 <strong>and the other side is fixed at the same time<\/strong>, because the anatomy that allowed it is usually present on both.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The largest pooled series, covering more than two thousand patients, gives a clear picture of how the odds fall with time:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Within 6 hours<\/strong> \u2014 the testicle is saved in around 97% of cases.<\/li>\n\n\n<li><strong>7 to 12 hours<\/strong> \u2014 around 79%.<\/li>\n\n\n<li><strong>13 to 18 hours<\/strong> \u2014 around 61%.<\/li>\n\n\n<li><strong>19 to 24 hours<\/strong> \u2014 around 43%.<\/li>\n\n\n<li><strong>25 to 48 hours<\/strong> \u2014 around 24%.<\/li>\n\n\n<li><strong>Beyond 48 hours<\/strong> \u2014 around 7%.<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Two things follow from those numbers, and they pull in opposite directions.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>First: the first six hours are not a slogan.<\/strong> The drop from 97% to 79% happens in the time it takes to decide whether to bother going in.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Second: late presentation is still a reason to go, not a reason to stay home.<\/strong> Roughly one testicle in five is still salvaged beyond 24 hours. Beyond that, a dead testicle left in place causes problems of its own, the other side still needs fixing to protect it, and the diagnosis needs confirming rather than assuming. Nobody should conclude from a delay that it is now pointless.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">One honest qualification about all of these figures: <strong>salvaged is not the same as normal.<\/strong> Saving a testicle means avoiding its removal at the operation. Long-term follow-up shows that a proportion of testicles that were saved go on to shrink anyway, and some series find that beyond about six hours the testicle rarely ends up fully normal even when it was not removed. The figures above describe what is taken out on the day, not what works years later.<\/p>\n\n\n\n<figure class=\"wp-block-image aligncenter size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"1200\" height=\"800\" data-attachment-id=\"2336\" data-permalink=\"https:\/\/drsoaraweeurology.com\/fr\/2021\/02\/19\/testicular-torsion-urologic-emer\/experienced-doctors-during-the-operation-2\/\" data-orig-file=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/02\/Surgical-correction.jpg?fit=1200%2C800&amp;ssl=1\" data-orig-size=\"1200,800\" data-comments-opened=\"1\" data-image-meta=\"{&quot;aperture&quot;:&quot;2.5&quot;,&quot;credit&quot;:&quot;Anna Bizon&quot;,&quot;camera&quot;:&quot;NIKON D3X&quot;,&quot;caption&quot;:&quot;Experienced doctors during the operation&quot;,&quot;created_timestamp&quot;:&quot;1407070775&quot;,&quot;copyright&quot;:&quot;Gpoint Studio&quot;,&quot;focal_length&quot;:&quot;50&quot;,&quot;iso&quot;:&quot;100&quot;,&quot;shutter_speed&quot;:&quot;0.01&quot;,&quot;title&quot;:&quot;Experienced doctors during the operation&quot;,&quot;orientation&quot;:&quot;1&quot;}\" data-image-title=\"Emergency surgical correction is required for testicular torsion.\" data-image-description=\"\" data-image-caption=\"&lt;p&gt;Emergency surgical correction is required for testicular torsion.&lt;\/p&gt;\n\" data-large-file=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/02\/Surgical-correction.jpg?fit=800%2C534&amp;ssl=1\" src=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/02\/Surgical-correction.jpg?resize=800%2C533&amp;ssl=1\" alt=\"Surgeons operating \u2014 emergency scrotal exploration is the only definitive treatment for testicular torsion\" class=\"wp-image-2336\" srcset=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/02\/Surgical-correction.jpg?w=1200&amp;ssl=1 1200w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/02\/Surgical-correction.jpg?resize=300%2C200&amp;ssl=1 300w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/02\/Surgical-correction.jpg?resize=1024%2C683&amp;ssl=1 1024w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/02\/Surgical-correction.jpg?resize=768%2C512&amp;ssl=1 768w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/02\/Surgical-correction.jpg?resize=16%2C12&amp;ssl=1 16w\" sizes=\"(max-width: 800px) 100vw, 800px\" \/><figcaption class=\"wp-element-caption\">Exploration is the only way to be certain, and the only treatment.<\/figcaption><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\">If a testicle is lost<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">It is a real loss and worth being honest about \u2014 but it is not the end of fertility or of normal hormone levels. <strong>One healthy testicle is generally enough for both<\/strong>, which is why fixing the remaining side matters so much. A prosthesis can be placed later for appearance if wanted, and it is entirely reasonable to ask about it rather than assume it is vanity. A <a href=\"https:\/\/drsoaraweeurology.com\/2023\/02\/05\/sperm-test-semen-analysis\/\">semen analysis<\/a> some months afterwards answers the fertility question for an individual.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Frequently Asked Questions about Testicular Torsion<\/h2>\n\n\n\n<h3 class=\"wp-block-heading\">What are the symptoms?<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Sudden severe pain in one testicle that does not ease with rest, position or painkillers, often with nausea or vomiting and scrotal swelling. It typically arrives abruptly at full intensity and frequently wakes someone from sleep. Anyone with this needs emergency assessment.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">My ultrasound was normal. Can I go home?<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Not on that basis alone. Doppler ultrasound can show flow in a testicle that is twisted, particularly with partial rotation or early scanning, and its accuracy depends on the operator. Torsion is diagnosed clinically, and where the story and examination fit, surgical exploration is the correct step regardless of the scan.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">How is it different from an infection?<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Epididymitis usually builds over days, often with burning on passing urine or fever. Torsion arrives suddenly and at full severity, commonly with nausea. The two are confused often enough that where there is doubt, exploring surgically is safer than treating with antibiotics and waiting.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">How quickly does it need treating?<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Within six hours the testicle is saved in around 97% of cases. That falls to roughly 79% at 7 to 12 hours, 61% at 13 to 18 hours, 43% at 19 to 24 hours, and around 24% between one and two days. Beyond 48 hours it is about 7%. Two things follow: the first six hours genuinely matter, and a delay is never a reason to stay at home, because roughly one in five is still saved beyond a day. Note also that avoiding removal on the day is not the same as a testicle that works normally years later.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">I keep getting brief attacks of severe testicular pain that go away. Does that matter?<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Yes, and it is worth raising specifically. That pattern suggests intermittent torsion, and it identifies anatomy that will eventually cause a full episode. Both testicles can be fixed as a planned operation before that happens.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Am I too old for this?<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">No. Adolescence is the peak, but torsion occurs in newborns and in men well into adulthood. Being outside the usual age band makes a wrong diagnosis more likely, not the condition impossible.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Will losing a testicle affect fertility?<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Usually not, provided the remaining testicle is healthy \u2014 one is generally sufficient for both fertility and hormone production. That is precisely why the other side is fixed during the same operation. A semen analysis some months later answers the question for an individual.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Arranging a consultation<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Torsion is not a condition to arrange an appointment for \u2014 go to an emergency department.<\/strong> For non-urgent matters, including recurrent brief episodes of testicular pain that have settled, Dr. Soarawee Weerasopone sees patients at <a href=\"https:\/\/www.bangkokhospital.com\/en\/bangkok\/doctor\/dr-soarawee-weerasopone-2\" target=\"_blank\" rel=\"noreferrer noopener\">Bangkok Hospital Headquarters<\/a> and at Samitivej Sriracha Hospital in Chonburi on <a href=\"tel:0880221445\">088-022-1445<\/a>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Bangkok Hospital Telemedicine is available for non-urgent consultations, including for international patients \u2014 arrange it in advance by email to the Urology department at <a href=\"mailto:bhquro@bdms.co.th\">bhquro@bdms.co.th<\/a>. Samitivej Sriracha is in-person only. Enquiries about cost are answered by the hospital, not by this website.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">References<\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Mellick LB, Sinex JE, Gibson RW, Mears K. A systematic review of testicle survival time after a torsion event. <em>Pediatr Emerg Care<\/em>. 2019;35(12):821\u2013825.<\/li>\n\n\n<li>Taghavi K, Dumble C, Hutson JM, Mushtaq I, Mirjalili SA. The bell-clapper deformity of the testis: the definitive pathological anatomy. <em>J Pediatr Surg<\/em>. 2021;56(8):1405\u20131410.<\/li>\n\n\n<li>Molokwu CN, Ndoumbe JK, Goodman CM. Cold weather increases the risk of scrotal torsion events: results of an ecological study of acute scrotal pain in Scotland over 25 years. <em>Sci Rep<\/em>. 2020;10(1):17958.<\/li>\n\n\n<li>Milivojevic S, Topalovic D, Dasic I, et al. Testicular atrophy following torsion in pediatric patients: results of a long-term follow-up. <em>Urology<\/em>. 2025;198:118\u2013124.<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Disclaimer:<\/strong> This content is written and reviewed by Dr. Soarawee Weerasopone, a board-certified urologist at Bangkok Hospital Headquarters, and is intended for education only. It is not medical advice, diagnosis or a prescription for any individual, and no advice, diagnosis or prescription is given through personal messaging channels or social media. Dr. Soarawee operates no public social media account; any account offering private consultation in his name is fraudulent. In an emergency in Thailand, call <strong>1669<\/strong>.<\/p>\n\n\n\n<script type=\"application\/ld+json\">\n{\n  \"@context\": \"https:\/\/schema.org\",\n  \"@graph\": [\n    {\n      \"@type\": \"MedicalWebPage\",\n      \"@id\": \"https:\/\/drsoaraweeurology.com\/2021\/02\/19\/testicular-torsion-urologic-emer\/#webpage\",\n      \"url\": \"https:\/\/drsoaraweeurology.com\/2021\/02\/19\/testicular-torsion-urologic-emer\/\",\n      \"name\": \"Testicular Torsion: Sudden Severe Pain in One Testicle Is an Emergency\",\n      \"description\": \"Testicular torsion requires immediate emergency assessment. A normal Doppler ultrasound does not exclude it, it is frequently mistaken for epididymitis, salvage rates fall steeply with every hour, and intermittent episodes allow elective fixation before the testicle is lost.\",\n      \"inLanguage\": \"en\",\n      \"datePublished\": \"2021-02-19\",\n      \"dateModified\": \"2026-08-29\",\n      \"lastReviewed\": \"2026-08-29\",\n      \"isPartOf\": { \"@id\": \"https:\/\/drsoaraweeurology.com\/#website\" },\n      \"author\": { \"@id\": \"https:\/\/drsoaraweeurology.com\/#physician\" },\n      \"reviewedBy\": { \"@id\": \"https:\/\/drsoaraweeurology.com\/#physician\" },\n      \"publisher\": { \"@id\": \"https:\/\/drsoaraweeurology.com\/#physician\" },\n      \"about\": { \"@id\": \"https:\/\/drsoaraweeurology.com\/2021\/02\/19\/testicular-torsion-urologic-emer\/#torsion\" },\n      \"audience\": { \"@type\": \"MedicalAudience\", \"audienceType\": \"Patient\" },\n      \"citation\": [\n        { \"@type\": \"ScholarlyArticle\", \"name\": \"A systematic review of testicle survival time after a torsion event\", \"isPartOf\": { \"@type\": \"Periodical\", \"name\": \"Pediatric Emergency Care\" }, \"datePublished\": \"2019\", \"identifier\": \"10.1097\/PEC.0000000000001287\" },\n        { \"@type\": \"ScholarlyArticle\", \"name\": \"The bell-clapper deformity of the testis: the definitive pathological anatomy\", \"isPartOf\": { \"@type\": \"Periodical\", \"name\": \"Journal of Pediatric Surgery\" }, \"datePublished\": \"2021\", \"identifier\": \"10.1016\/j.jpedsurg.2020.06.023\" },\n        { \"@type\": \"ScholarlyArticle\", \"name\": \"Cold weather increases the risk of scrotal torsion events: an ecological study over 25 years\", \"isPartOf\": { \"@type\": \"Periodical\", \"name\": \"Scientific Reports\" }, \"datePublished\": \"2020\", \"identifier\": \"10.1038\/s41598-020-74878-0\" },\n        { \"@type\": \"ScholarlyArticle\", \"name\": \"Testicular atrophy following torsion in pediatric patients: results of a long-term follow-up\", \"isPartOf\": { \"@type\": \"Periodical\", \"name\": \"Urology\" }, \"datePublished\": \"2025\", \"identifier\": \"10.1016\/j.urology.2025.01.017\" }\n      ],\n      \"disambiguatingDescription\": \"The earlier version carried the emergency message in the body but gave no emergency number and did not state three points that determine outcome. A normal Doppler ultrasound does not exclude torsion, since flow may persist with partial rotation and accuracy is operator-dependent; torsion is a clinical diagnosis and exploration should not await or be deferred by imaging. Epididymitis is the principal differential and misdiagnosis leads to antibiotic treatment while the testicle infarcts. Torsion occurs in neonates and in adult men well beyond the adolescent peak. Intermittent torsion permits elective bilateral fixation. Revised 29 August 2026 with verified figures: hour-by-hour salvage rates from a pooled series of over 2000 patients, bell clapper prevalence of approximately 5 to 16 percent at autopsy, an incidence of about one in four thousand males under 25 per year, and the qualification that salvage at operation is not equivalent to long-term testicular viability. The cold-weather association was checked rather than removed and is supported by independent series from Scotland, Taiwan and Israel as an ecological observation of unproven mechanism.\"\n    },\n    {\n      \"@type\": \"MedicalCondition\",\n      \"@id\": \"https:\/\/drsoaraweeurology.com\/2021\/02\/19\/testicular-torsion-urologic-emer\/#torsion\",\n      \"name\": \"Testicular torsion\",\n      \"description\": \"Rotation of the testis on the spermatic cord occluding its blood supply, causing ischaemia and infarction. Usually predisposed by a bell clapper anatomical variant in which the testis is inadequately fixed within the tunica vaginalis, reported in approximately 5 to 16 percent of testes at autopsy and bilateral in most affected men. Incidence is approximately one in four thousand males under 25 years per year, peaking in adolescence.\",\n      \"signOrSymptom\": \"Abrupt severe unilateral testicular pain at full intensity, often waking the patient from sleep, unrelieved by position or analgesia, commonly with nausea, vomiting and scrotal swelling.\",\n      \"differentialDiagnosis\": {\n        \"@type\": \"DDxElement\",\n        \"diagnosis\": { \"@type\": \"MedicalCondition\", \"name\": \"Epididymitis\" },\n        \"distinguishingSign\": { \"@type\": \"MedicalSignOrSymptom\", \"name\": \"Epididymitis typically develops over days with dysuria or fever, whereas torsion is abrupt and maximal at onset. Where doubt exists, surgical exploration is safer than empirical antibiotic treatment.\" }\n      },\n      \"typicalTest\": {\n        \"@type\": \"MedicalTest\",\n        \"name\": \"Doppler ultrasound of the scrotum\",\n        \"description\": \"May support the diagnosis but does not exclude it. Flow can persist with partial torsion and accuracy is operator-dependent; imaging must not delay exploration where clinical suspicion is high.\"\n      },\n      \"possibleTreatment\": {\n        \"@type\": \"MedicalProcedure\",\n        \"name\": \"Emergency scrotal exploration with detorsion and bilateral orchidopexy, or orchiectomy where the testis is non-viable\",\n        \"howPerformed\": \"The cord is untwisted and perfusion assessed; a viable testis is fixed to the scrotal wall and the contralateral testis fixed at the same operation, since the predisposing anatomy is usually bilateral.\",\n        \"expectedPrognosis\": \"Pooled data from over 2000 patients give testicular salvage of approximately 97% within 6 hours, 79% at 7-12 hours, 61% at 13-18 hours, 43% at 19-24 hours, 24% at 25-48 hours and 7% beyond 48 hours. Salvage remains possible beyond 24 hours in roughly one in five, so late presentation warrants exploration rather than expectant management. Salvage at operation is not equivalent to long-term viability: a proportion of preserved testes subsequently atrophy.\"\n      },\n      \"possibleComplication\": \"Testicular infarction and loss; subsequent atrophy of a testis salvaged at operation.\"\n    },\n    {\n      \"@type\": \"FAQPage\",\n      \"@id\": \"https:\/\/drsoaraweeurology.com\/2021\/02\/19\/testicular-torsion-urologic-emer\/#faq\",\n      \"isPartOf\": { \"@id\": \"https:\/\/drsoaraweeurology.com\/2021\/02\/19\/testicular-torsion-urologic-emer\/#webpage\" },\n      \"mainEntity\": [\n        {\n          \"@type\": \"Question\",\n          \"name\": \"My scrotal ultrasound was normal. Can I go home?\",\n          \"acceptedAnswer\": { \"@type\": \"Answer\", \"text\": \"Not on that basis alone. Doppler ultrasound can show flow in a testicle that is twisted, particularly with partial rotation or early scanning, and accuracy depends on the operator. Torsion is diagnosed clinically, and where history and examination fit, surgical exploration is correct regardless of the scan.\" }\n        },\n        {\n          \"@type\": \"Question\",\n          \"name\": \"How is testicular torsion different from an infection?\",\n          \"acceptedAnswer\": { \"@type\": \"Answer\", \"text\": \"Epididymitis usually builds over days, often with burning on passing urine or fever, while torsion arrives suddenly at full severity, commonly with nausea. Where there is doubt, exploring surgically is safer than treating with antibiotics and waiting.\" }\n        },\n        {\n          \"@type\": \"Question\",\n          \"name\": \"How quickly does testicular torsion need treating?\",\n          \"acceptedAnswer\": { \"@type\": \"Answer\", \"text\": \"Within six hours the testicle is saved in around 97% of cases. That falls to roughly 79% at 7 to 12 hours, 61% at 13 to 18 hours, 43% at 19 to 24 hours, and around 24% between one and two days. Beyond 48 hours it is about 7%. The first six hours genuinely matter, and a delay is never a reason to stay at home, because roughly one in five is still saved beyond a day. Avoiding removal on the day is not the same as a testicle that works normally years later.\" }\n        },\n        {\n          \"@type\": \"Question\",\n          \"name\": \"I keep getting brief attacks of severe testicular pain that resolve. Does that matter?\",\n          \"acceptedAnswer\": { \"@type\": \"Answer\", \"text\": \"Yes. That pattern suggests intermittent torsion and identifies anatomy that will eventually cause a full episode. Both testicles can be fixed as a planned operation before that happens.\" }\n        },\n        {\n          \"@type\": \"Question\",\n          \"name\": \"Will losing one testicle affect fertility?\",\n          \"acceptedAnswer\": { \"@type\": \"Answer\", \"text\": \"Usually not, provided the remaining testicle is healthy, since one is generally sufficient for both fertility and hormone production. This is why the other side is fixed during the same operation.\" }\n        }\n      ]\n    }\n  ]\n}\n<\/script>\n","protected":false},"excerpt":{"rendered":"<p>The clock starts the moment the pain does. What testicular torsion is, why a normal ultrasound does not rule it out, why it is so often mistaken for an infection, and the warning episodes that come months before the real thing.<\/p>","protected":false},"author":185281453,"featured_media":10105,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"advanced_seo_description":"Sudden severe pain in one testicle needs emergency assessment now. Why a normal scan does not exclude torsion, why it is misdiagnosed as epididymitis, and what the warning episodes mean.","jetpack_seo_html_title":"Testicular Torsion: Symptoms & Emergency Treatment | Dr. Soarawee","jetpack_seo_noindex":false,"jetpack_seo_schema_type":"","_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_wpcom_ai_launchpad_first_post":false,"_jetpack_feature_clip_id":0,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"{title}\n\n{excerpt}\n\n{url}","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":true,"jetpack_social_options":{"image_generator_settings":{"template":"highway","default_image_id":0,"font":"","enabled":false},"version":2},"_wpas_customize_per_network":false,"jetpack_post_was_ever_published":false},"categories":[1363],"tags":[1417],"class_list":["post-2329","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-mens-health","tag-testicular-torsion"],"jetpack_publicize_connections":[],"jetpack_likes_enabled":false,"jetpack_sharing_enabled":true,"jetpack_shortlink":"https:\/\/wp.me\/pgZdrK-Bz","jetpack_featured_media_url":"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2026\/04\/Testicular-Torsion.jpg?fit=1200%2C630&ssl=1","_links":{"self":[{"href":"https:\/\/drsoaraweeurology.com\/fr\/wp-json\/wp\/v2\/posts\/2329","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/drsoaraweeurology.com\/fr\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/drsoaraweeurology.com\/fr\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/drsoaraweeurology.com\/fr\/wp-json\/wp\/v2\/users\/185281453"}],"replies":[{"embeddable":true,"href":"https:\/\/drsoaraweeurology.com\/fr\/wp-json\/wp\/v2\/comments?post=2329"}],"version-history":[{"count":28,"href":"https:\/\/drsoaraweeurology.com\/fr\/wp-json\/wp\/v2\/posts\/2329\/revisions"}],"predecessor-version":[{"id":11773,"href":"https:\/\/drsoaraweeurology.com\/fr\/wp-json\/wp\/v2\/posts\/2329\/revisions\/11773"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/drsoaraweeurology.com\/fr\/wp-json\/wp\/v2\/media\/10105"}],"wp:attachment":[{"href":"https:\/\/drsoaraweeurology.com\/fr\/wp-json\/wp\/v2\/media?parent=2329"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/drsoaraweeurology.com\/fr\/wp-json\/wp\/v2\/categories?post=2329"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/drsoaraweeurology.com\/fr\/wp-json\/wp\/v2\/tags?post=2329"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}