Chapter 30 · Acute lower urinary tract conditions
Testicular torsion
Definition
Testicular torsion is twisting of the spermatic cord, compromising testicular blood supply.
The likelihood of preserving function is highest in the first 4–6 hours, but late presentation does not remove the need for emergency surgical exploration.
Clinical presentation
- Sudden, severe pain in the scrotum, groin, or lower abdomen.
- Scrotal swelling and redness.
- Nausea, vomiting.
- High-riding testis with a horizontal lie.
- Absent cremasteric reflex.
Diagnosis
- Doppler ultrasonography helps when the diagnosis is uncertain, but may be falsely negative in early, partial, or intermittent torsion.
- An inconclusive result warrants surgical exploration.
Emergency management
- Emergency surgical intervention:
- Testicular detorsion.
- Assessment of viability (orchiectomy if nonviable).
- Orchiopexy (fixation) of the contralateral testis.
Algorithm
| Step | Action |
|---|---|
| 1 | Clinical suspicion |
| 2 | Diagnostic uncertainty: ultrasonography only if it does not delay surgery |
| 3 | Emergency surgery |
| 4 | Detorsion + assessment of viability |
| 5 | Orchiopexy (affected and contralateral testes) |