Overview

If you have sudden, severe testicle pain, it could be caused by testicular torsion. This is when a testicle twists on itself and cuts off the blood supply.

This is an emergency and needs treatment urgently. Not getting urgent treatment might lead to testicle damage or loss of the testicle.

The testicle can be untwisted by an operation called scrotal exploration surgery.

Going to hospital for a diagnosis

People usually come into the hospital with sudden, severe pain in the testicle. At the hospital, we:

• take your medical history
• do a physical examination of your scrotum
• take a urine (pee) sample to test for infection and blood

More tests are not usually helpful because of the urgency of the situation.

It is difficult to be completely certain that someone has testicular torsion. The doctors might recommend having scrotal exploration surgery if they think testicular torsion is likely.

Scrotal exploration surgery

Scrotal exploration surgery is done using a general anaesthetic. It's an operation to untwist the testicle.

This procedure is usually done after an emergency admission, and as soon as possible after the symptoms start.

Preparing for scrotal exploration surgery

You will be asked not to eat or drink anything else before surgery.

The doctor will talk to you about the surgery, and any possible risks. You will then be asked to sign a consent form. Please make sure that you have discussed any concerns and asked any questions you have.

The doctor will draw an arrow on your skin to mark the painful side.

What happens during surgery

This surgery is done under a general anaesthetic.

A surgical cut (incision) is made into the scrotum. This is so we can examine the testicle.

If the testicle is twisted, the doctor untwists it and checks the blood supply and health of the testicle. If the testicle is healthy, it can be stitched to stop it from twisting again in the future. The other testicle will be stitched in the same way, to prevent a torsion from happening on that side.

If the doctor finds the testicle is unhealthy, or is too badly damaged to recover, the testicle might need to be removed. The other testicle would be stitched to prevent twisting.

Sometimes, the doctor finds that the testicle is not actually twisted, and there is no need to operate on the other testicle. The cut will be stitched up and no treatment is needed. This happens to 1 in 10 people having this type of surgery. 

Other treatment options

There are no safe alternatives to this procedure for suspected testicular torsion. Observation (watching and waiting) risks loss of the testicle and can risk damage to the other, healthy testicle.

A scan is not completely accurate, and might delay surgery and risk loss of the testicle.

Risks of surgery

Most people do not have any side effects with this procedure, but there are some risks.

There are potential risks that happen in up to 10 in 100 people who have scrotal exploration surgery.

• It might be possible to feel the stitch used to fix the testicles, through the skin.
• A collection of blood (haematoma) can form around the testicle after surgery. This might resolves slowly, or need surgery to remove it.
• Infection of the cut or of the testicle requiring more treatment. 
• Discomfort or pain in the testicles that can be ongoing.

There are also risks that happen in less than 2 in 100 people who have this surgery.

• Shrinkage of the testicle, even if the testicle is saved.
• Reduction or loss of fertility.

The risks of a general anaesthetic in a fit, young person are very small. Read more about risks of a general anaesthetic. 

After scrotal exploration surgery

After surgery, you will spend some time in the recovery area to be monitored as you wake up from the anaesthetic. You will then go back to a ward.

• Your blood pressure, pulse and the wound will be checked regularly by the nursing team.
• You can start to drink and eat after surgery.
• You can get out of bed a few hours after your surgery, please ask the nursing staff if you need help with this. .

Most people can go home on the same day, or the day after surgery.

Before you go home, your doctor will explain what was found and done during the surgery, and if one or both sides have been treated.

Make sure that you are clear about what the doctor explains to you. If you are in any doubt, ask the doctor or nurse caring for you to explain further.

Side effects after surgery

You might feel sleepy (drowsy) for 1 to 2 days as the anaesthetic wears off. You should rest and not make any important decisions, sign any legal documents or operate machinery for at least 24 hours after your operation.

Pain

Your groin and scrotum might be uncomfortable for 7 to 10 days. This will usually be relieved by simple painkillers (such as paracetamol and ibuprofen) which you will be given to go home with if you do not have any at home. Always follow the instructions on the packet, and do not take more than the recommended amount (dose).

You will need to take them regularly for the first few days to prevent pain building up. After a few days, you might be able to take them only when you need them.

Sore throat

You might notice that you have a sore throat afterwards. This is due to the breathing tube placed in your throat for the general anaesthetic. This discomfort will go in a day or two.

Stitches

Dissolvable stitches are usually used in the skin, and they do not need removing. They will usually disappear after 3 weeks.

After you leave hospital

When you are sent home from hospital (discharged), you should:

• return to work when you feel comfortable to do so. This is typically after a week (or longer if your work is physical, or if you are driving a public vehicle or HGV, check with your licensing authority) 
• make sure that you are fit to drive after surgery and can perform an emergency stop comfortably
• not do vigorous exercise (including sports) for 4 to 6 weeks
• avoid having sex until you feel comfortable (usually 2 weeks)

Looking after your wound

You might be given a scrotal support (jockstrap). Try to wear this, or tight briefs or cycling shorts, for the week after surgery to support the area and reduce the risk of bruising after surgery.

You will can shower after 48 hours, but do not soak in a bath or go swimming for 10 to 14 days.

Follow-up appointment

An outpatient appointment in the urology clinic at Guy’s Hospital will normally be arranged, for 6 to 8 weeks after your surgery.