Testicular torsion

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

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

• 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.

• 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.

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

• 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.

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

• Testicular torsion is a urological emergency and is most common in puberty.
• Prompt diagnosis and management is required to prevent severe complications, such as testicular infarction and atrophy.
• Patients present with sudden, severe testicular pain (often unilateral), along with an absent cremasteric reflex on the affected side.
• Immediate surgical exploration is performed in suspected cases without waiting for imaging.
• Management is primarily emergency surgical detorsion with contralateral testicular fixation.