Attending to the condition known as testicular torsion is one of those “drop everything” situations for urologists. It occurs when a testicle rotates, twisting the spermatic cord that brings blood to the scrotum. The reduced blood flow causes sudden and often severe pain and swelling. If the testicle rotates several times, blood flow to it can be entirely blocked, causing damage more quickly.

It's not clear why testicular torsion occurs. Most males who get the condition have an inherited trait that allows the testicle to rotate freely inside the scrotum. This inherited condition often affects both testicles. Not every male with the trait will have testicular torsion, however.

Testicular torsion often occurs several hours after vigorous activity, a minor injury to the testicles, or sleep.  Cold temperature or rapid growth of the testicle during puberty may also play a role.

The condition is most commonly experienced between the ages of 12 and 16, and/or among men who have had testicular pain that went away without treatment. Testicular torsion can also run in families.

Emergency surgery is usually the order of the day with testicular torsion, and if treated quickly enough, the testicle can usually be saved. If, however, the blood flow has been cut off for too long, a testicle might become so badly damaged that it has to be removed.

Symptoms of testicular torsion will manifest themselves fast and furiously. Look out for:

·         Sudden, severe pain in the scrotum

·         A testicle that's positioned higher than normal or at an unusual angle

·         Swelling of the scrotum

·         Abdominal pain

·         Nausea and vomiting

·         Painful urination

·         Fever

Most of the time your doctor will confirm whether or not you have testicular torsion with a brief physical examination. Other tests might be necessary, however. These might include a urine test and a scrotal ultrasound.

Speed is key. The sooner the testicle is untwisted, the greater the chance it can be saved. The risk that you'll need testicle removal is only 5 percent when treatment occurs within six hours of the start of pain. The risk increases to 90 percent when treatment occurs more than 48 hours after pain begins.

Surgery is inevitable. Even if the doctor can untwist the testicle by pushing on the scrotum (a procedure known as manual detorsion), you will still require surgery to prevent the torsion from recurring.