An urological emergency! Have an high index of suspicion especially in young males (but can be of any age). If history and examination is suggestive of testicular torsion, then immediately consider surgery for exploration and/or repair (do not delay this by doing any further diagnostic tests)
History
- Sudden onset severe testicular pain
- Pain can be on and off suggesting a period of torsion and detorsion
- Nausea and vomiting is common
- Abdominal pain is common
- Pain is not relieved by lifting the testis
- Scrotal swelling
Examination
- Erythema might develop on the surface
- Absent cremasteric reflex
- Pain not eased by elevation
- Testicle is tender on palpation
- With time, scrotum becomes oedematous; there may be reactive hydrocele (i.e. fluid build-up)
- High-riding testicle: the affected testicle may appear higher than the unaffected side
Risk factors
- Aged under 25 years (adolescent and young males)
- Neonates
- Bell clapper deformity
Investigations
- Doppler USS but only perform if diagnosis is uncertain —> look for whirlpool sign
Management
- Consent for ?bilater orchidectomy + bilateral orchidoplexy (fixation)