Surgery for testicular torsion

Testicular torsion is an emergency in which a testicle twists on its cord and loses its blood supply. Surgery untwists it, checks whether it can be saved, and stitches both testicles in place so they are very unlikely to twist again.

Also called Testicular torsion, Testicular torsion surgery, Scrotal exploration, Emergency scrotal exploration, Detorsion and orchiopexy, Bilateral orchiopexy for torsion, Twisted testicle, Twisted testicle surgery

Where: Emergency department, then the operating room
Anesthesia: General anesthesia
Time in the room: 30 minutes to 1 hour
Hospital stay: Usually home the same day or the next morning
Back to normal: 1 to 2 weeks
Back to work: School or desk work in 3 to 7 days; sports and heavy lifting after 2 to 4 weeks

See the steps

Spermatic cordTesticleTunica vaginalisScrotal skin

Where it happens. The highlighted part is what this procedure treats.

Overview

Testicular torsion happens when a testicle rotates and twists the spermatic cord it hangs from. The twist cuts off the testicle's blood supply. It causes sudden, severe pain in one testicle, often with nausea or vomiting, and sometimes pain low in the belly. It can start during sleep, sports or for no clear reason. It is most common in teenagers but can happen at any age, including in newborns. It affects roughly 1 in 4,000 males under age 25 each year.

Time matters more than anything else. When blood flow is restored within about 6 hours of the pain starting, the testicle can usually be saved. After 12 hours the chances fall quickly, and after 24 hours most testicles cannot be saved. Anyone with sudden, severe testicle pain should go to an emergency room right away. Teenage boys are often embarrassed and wait; parents can help by making it easy to talk about.

In the emergency room, the doctor examines the scrotum and often orders a Doppler ultrasound, which shows blood flow. If the signs strongly point to torsion, surgery should not be delayed for the scan.

In surgery, the urologist opens the scrotum, untwists the cord, and watches to see if the testicle recovers. A testicle that recovers is stitched in place. One that has died is removed. The other testicle is almost always stitched in place too, because the same loose attachment that allowed the twist is usually present on both sides.

The parts of your body involved

Normally each testicle is attached along its back to the inside of the scrotum, which keeps it from spinning. In many people who have torsion, the thin sac around the testicle, called the tunica vaginalis, attaches too high on the cord. The testicle then hangs free inside the sac like the clapper inside a bell, which is why this is called a bell clapper deformity. When the testicle spins, the cord twists. The thin-walled veins close first, so blood gets in but cannot get out, and the testicle swells. Then the artery closes, and the testicle starts to die.

Testicle
Makes sperm and testosterone. Without blood flow, its cells begin to die within hours.
Spermatic cord
The bundle carrying the testicle's artery, veins, nerves and the vas deferens. This is what twists.
Tunica vaginalis
The thin sac around the testicle. When it attaches too high, the testicle can spin inside it.
Epididymis
The coiled tube on the back of the testicle. It twists along with the testicle.
The other testicle
Usually has the same loose attachment and is at risk of twisting in the future.

Why it’s done

Surgery is an emergency treatment. It has several goals at once.

Saving the testicle
Untwisting the cord quickly restores blood flow before the testicle dies.
Stopping the pain
The severe pain of torsion usually eases once the cord is untwisted.
Protecting the other side
Stitching the other testicle in place prevents it from twisting in the future.
Removing a testicle that has died
A dead testicle left in place can become infected and cause ongoing pain.
Getting a clear answer
Other problems can mimic torsion. Looking directly at the testicle settles the question when tests are unclear.

Other options

Untwisting by hand in the emergency room
A doctor can sometimes untwist the testicle by hand, usually turning it outward toward the thigh. If it works, pain eases quickly. Surgery is still needed soon to confirm it is fully untwisted and to stitch both testicles in place.
Ultrasound before deciding
When the diagnosis is uncertain, a Doppler ultrasound helps. When the signs clearly point to torsion, waiting for a scan can cost the testicle.
Planned surgery for twisting that comes and goes
Some boys and men have short episodes of sudden pain that go away on their own. This can be twisting and untwisting. A urologist may recommend stitching both testicles in place as a planned, non-emergency operation.
No surgery
Not recommended. Even if the pain settles, a testicle that stayed twisted will usually die and shrink, and the other testicle remains at risk.

In the operating room, step by step

Press play or pick a step. Each drawing shows what your surgeon is doing at that moment. Your team may do some steps differently.

Anesthesia teamYouSurgeon

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1. Going to sleep

You lie on your back on the operating table and the anesthesia team puts you to sleep. The scrotum is cleaned and draped. The team moves quickly, because every minute of restored blood flow counts.

You lie on your back on the operating table and the anesthesia team puts you to sleep. The scrotum is cleaned and draped. The team moves quickly, because every minute of restored blood flow counts.
The urologist makes a cut, usually along the center seam of the scrotum so both sides can be reached through one opening. Some surgeons make one cut on each side instead.
The sac around the testicle is opened. A twisted testicle often looks dark red, blue or black, and the cord is wound around itself, often by one or more full turns.
The cord is untwisted. The testicle is wrapped in warm, moist gauze, and the surgeon waits several minutes to see whether its color returns to pink. Sometimes a small cut is made in the testicle's tough outer layer to check for fresh, bright bleeding, a sign it is alive.
More detail
When a testicle has been twisted for a long time, it may look borderline. Surgeons judge it by color, by how quickly it bleeds from a small cut, and by experience. When in doubt, many surgeons keep a borderline testicle and follow it, since some recover partly.
A testicle that recovers is fixed to the inside of the scrotum with stitches in two or three spots, or placed into a snug pocket, so it is very unlikely to spin again.
More detail
Many surgeons use permanent stitches for this. They are small and buried, though some people can feel them as tiny knots later.
If the testicle stays black and does not bleed, it has died. The cord is tied off and the testicle is removed. This is called an orchiectomy. An implant can be placed later, once healing is complete.
The other testicle almost always has the same loose attachment. Through the same cut, it is stitched in place too. This makes it very unlikely that the other testicle will ever twist.
The layers and skin are closed with dissolving stitches. A dressing and snug support go on before you wake up.

After the operation

Right afterward

Waking up
You wake up with a sore scrotum and a snug support. The sharp twisting pain is usually gone.
What was found
The urologist tells you, or your parents, whether the testicle was saved or removed and that the other side was fixed.
Pain and nausea
You get medicine as needed. Most people can eat and drink soon after waking.
Passing urine
The team checks that you can pass urine before you leave.
Going home
Many people go home the same day. Surgery in the middle of the night may mean staying until morning.

At home

Pain
Soreness lasts several days. Acetaminophen and ibuprofen usually control it. A short supply of stronger medicine may be given.
Ice and support
Ice on and off for 48 hours. Wear snug briefs or an athletic supporter for 1 to 2 weeks.
The wound
Keep it clean and dry. Stitches dissolve in 1 to 3 weeks. Some bruising and swelling are normal.
Showering
Usually after 24 to 48 hours. No baths, hot tubs or swimming for about 2 weeks.
Activity
Walk from the first day. Rest more in the first few days.
Sports and lifting
No sports, bike riding, gym class or heavy lifting for about 2 to 4 weeks, as your urologist advises.
School and work
Most people return to school or desk work in 3 to 7 days.
Sex
When comfortable, usually after about 2 weeks.
Follow-up
A visit in a few weeks checks healing. If the testicle was saved after a long twist, its size is checked over the next months.

Recovery timeline

Hour 0
Pain starts
Sudden, severe pain in one testicle. Go straight to the emergency room.
Within about 6 hours
The best window
Untwisting within this time saves most testicles.
Day 0
Surgery
The cord is untwisted, the testicle is fixed or removed, and the other side is fixed.
Days 1 to 3
Sore and swollen
Rest, ice and pain medicine. The intense pain of the twist is gone.
Week 1
Back to school or work
Most people are moving normally and back to school or desk work.
Weeks 2 to 4
Back to sports
Sports and heavy lifting usually resume, as your urologist advises.
Months 1 to 6
Checking the saved testicle
A testicle that was twisted for many hours may slowly shrink. Your urologist checks its size.
Long term
Protected
With both testicles stitched in place, twisting again is very unlikely. If a testicle was removed, an implant can be placed if you want one.

What it feels like

Torsion turns an ordinary day or night into an emergency within minutes. The pain is intense, things move fast, and many people do not have time to process what is happening until afterward.

The pain
Sudden, severe pain in one testicle, sometimes spreading to the belly, often with nausea or vomiting. Many teens are embarrassed and try to hide it.
What helpsGo to the emergency room right away. Parents: if your son says his testicle or lower belly hurts, take it seriously and go.
In the emergency room
The exam is painful and embarrassing. Everything happens quickly, which can feel frightening.
What helpsAsk for pain medicine. Ask the team to explain what they think is happening and what comes next.
Signing consent
Hearing that the testicle might have to be removed is upsetting for patients and parents.
What helpsThe team is moving fast to give the testicle its best chance. The other testicle is protected either way, and one healthy testicle usually supports normal hormones and fertility.
Waking up
Sore and groggy, but often relieved that the sharp pain is gone. The first question is usually whether the testicle was saved.
What helpsAsk the urologist to explain what was found and what it means for you.
If the testicle was removed
Sadness, anger, guilt about waiting, or worry about appearance and the future are all common.
What helpsTalk about it with family, your urologist or a counselor. An implant can be placed later if you want one.
The weeks after
Swelling and soreness fade. Some people feel small knots from the stitches and worry something is wrong.
What helpsThese are usually the fixing stitches. Ask about any lump at your follow-up visit.

How well it works

Success means the testicle is saved when possible, and both sides are protected from twisting in the future.

Saving the testicle
When surgery happens within about 6 hours of the pain starting, about 9 in 10 testicles or more can be saved. The longer the twist lasts, the lower the chance.
The saved testicle
A testicle that was twisted for many hours may shrink over the following months, even after blood flow returns. Your urologist checks it at follow-up.
Protection
Stitching both testicles in place makes twisting again very unlikely.
Hormones and fertility
One healthy testicle usually makes enough testosterone and sperm for normal sexual function and fathering children.
Implant
If a testicle was removed, a silicone implant can be placed in a separate, planned operation, usually after a few months of healing.

Risks

Every operation has risks. These are the ones people ask about most, with honest odds where good numbers exist. Your surgeon’s own results matter more than averages.

Common

Swelling and bruising

Swelling and bruising of the scrotum for 1 to 2 weeks.

Soreness

Aching for several days, usually controlled with simple pain medicine and ice.

The saved testicle shrinks

Shrinking is common when the twist lasted many hours. It is less likely when surgery is quick.

Less common

Wound infection

Redness, warmth or drainage, usually treated with antibiotics.

Bleeding into the scrotum (hematoma)

A tense, painful swelling from blood collecting. Most settle with rest and support.

Feeling the stitches

Small knots from the fixing stitches can sometimes be felt through the skin.

Rare

Twisting again

Very rare after both testicles have been stitched in place.

Long-lasting pain

Ongoing pain after healing is uncommon.

Anesthesia problems

Serious reactions to anesthesia are rare in healthy young people.

Call your care team or go to the emergency room if

New sudden, severe pain in either testicle: go to the emergency room
Fever of 101°F (38.3°C) or higher
Swelling in the scrotum that keeps getting bigger or becomes tense
Bleeding that soaks through the dressing and does not stop after 10 minutes of firm pressure
Redness spreading across the scrotum, pus, or a bad smell
Pain that keeps getting worse, or is not controlled by your medicine
You cannot pass urine for 8 hours after surgery

Questions to ask your surgeon

Was the testicle saved, and how healthy did it look?
How long do you think it was twisted?
Did you fix the other testicle, and with what kind of stitches?
Is the saved testicle likely to shrink, and how will we check?
Will I need an ultrasound later?
If the testicle was removed, can I have an implant, and when?
Will this affect my testosterone or fertility?
When can I go back to school, work and sports?
Can it happen again?
What should I do if I get sudden testicle pain in the future?

Words you may hear

Testicular torsion: Twisting of the testicle on its cord, cutting off its blood supply.
Spermatic cord: The bundle of blood vessels, nerves and the vas deferens that holds up the testicle.
Bell clapper deformity: A loose attachment that lets the testicle swing freely inside its sac, like a bell's clapper.
Detorsion: Untwisting the cord.
Orchiopexy: Stitching a testicle in place inside the scrotum.
Orchiectomy: Surgery to remove a testicle.
Doppler ultrasound: An ultrasound that shows whether blood is flowing to the testicle.
Cremasteric reflex: A reflex that pulls the testicle up when the inner thigh is stroked. It is often missing with torsion.
Intermittent torsion: Twisting that comes and goes on its own, causing short episodes of pain.
Torsion of the appendix testis: Twisting of a tiny, harmless tag of tissue on the testicle. It causes pain but usually does not need surgery.
Atrophy: Shrinking of the testicle after its blood supply was cut off.
Testicular prosthesis: A silicone implant shaped like a testicle.

Common questions

How do I know if testicle pain is torsion?

You cannot tell for sure at home. Sudden, severe pain in one testicle, especially with nausea or vomiting, should be treated as torsion until a doctor says otherwise. Go to the emergency room.

Can a doctor untwist it without surgery?

Sometimes a doctor can untwist it by hand in the emergency room, which can relieve pain and restore blood flow. Surgery is still needed soon to check it and stitch both testicles in place.

Why did they operate on my other testicle?

The loose attachment that let one testicle twist is usually present on both sides. Stitching the other testicle in place prevents it from twisting in the future.

Will I have normal testosterone and be able to have children?

Usually yes. One healthy testicle typically makes enough testosterone and sperm. Talk with your urologist if you have concerns later.

My pain came and went on its own. Could that be torsion?

It could be twisting that untwisted by itself. See a urologist soon. A planned operation to stitch both testicles in place may be recommended.

Can newborn babies get torsion?

Yes, though it is rare, and it often happens before birth. A newborn with a swollen, firm or discolored scrotum needs urgent evaluation by a pediatric urologist.

What else can cause sudden testicle pain?

Twisting of a tiny tag of tissue on the testicle, infection of the epididymis, an injury, or a hernia can all cause pain. Because torsion cannot wait, any sudden severe pain needs an emergency visit.

Sources this page draws on

Urology Care Foundation, Testicular Torsion
European Association of Urology, EAU Guidelines on Paediatric Urology (acute scrotum)
MedlinePlus (U.S. National Library of Medicine), Testicular torsion
Journal of Urology, Development and initial validation of a scoring system to diagnose testicular torsion in children (TWIST score, Barbosa and colleagues) (2013)

Written November 2026. This page explains what usually happens. It is not medical advice and does not replace a conversation with your own surgeon, whose plan for you comes first.

Surgery for testicular torsion

Overview

The parts of your body involved

Why it’s done

Other options

Getting ready

When the pain starts

In the emergency room

Right before surgery