Testicular Torsion

Definition

• Testicular torsion: Twisting of the spermatic cord leading to impaired blood flow to the testicle, resulting in ischaemia.

Epidemiology

• Most common in neonates and adolescents.
• Peak incidence: puberty (12-18 years).

Aetiology & Risk Factors

• Believed torsion: Anatomical abnormality where the testes are more mobile within the scrotum.
• Testicular trauma or rapid growth during puberty.
• Previous torsion event that resolved spontaneously.

Clinical Presentation

• Sudden, severe testicular pain, often unilateral.
• Associated nausea and vomiting.
• Swollen, erythematous and tender testicle.
• High-riding testicle and horizontal lie on examination.
• Absent cremasteric reflex on the affected side.

Investigations

• Colour Doppler ultrasound: Decreased or absent blood flow in the affected testicle.
• Immediate surgical exploration is indicated in suspected cases without waiting for imaging.

Management

• Emergency surgical detorsion and fixation, ideally within 6 hours to preserve testicular viability.
• Contralateral testicular fixation due to risk of torsion in the other testicle.
• If necrosis is present, orchiectomy (testicle removal) is performed.

Complications

• Testicular infarction and atrophy.
• Infertility if bilateral torsion or subsequent torsion of the contralateral testicle occurs.