Introduction

Learning objectives

Recognize the clinical presentation of testicular torsion.
Understand why it is a time-dependent surgical emergency.
Know the general principles of its treatment.

Video lesson

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Video pending upload (embedded YouTube)

Summary

What is it?

Testicular torsion occurs when the spermatic cord twists on its axis, progressively compromising blood flow to the testis.

It is a time-dependent surgical emergency.

Clinical presentation

It should be suspected in the presence of:

sudden, severe testicular pain;
nausea or vomiting;
scrotal swelling;
high-riding testicle or abnormal position;
absence of the cremasteric reflex, although no single sign excludes it.

It is especially common in adolescents, but can occur at any age.

Diagnosis

The diagnosis is essentially clinical.

Doppler ultrasound can be useful when there is diagnostic doubt, but it should not delay surgical exploration when clinical suspicion is high.

Why does time matter?

The longer the ischemia time, the lower the chance of saving the testis.

Treatment

With confirmed or highly suspected torsion, urgent surgical exploration is performed.

The following are usually performed:

detorsion;
viability assessment;
orchiopexy;
fixation of the contralateral testis.

If the testis is irreversibly damaged and clearly nonviable, orchiectomy may be necessary.

Key concept

In an adolescent with acute testicular pain, torsion must be ruled out quickly.

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Practical algorithm

Is the patient stable? If not → immediate stabilization.
Is there infection associated with obstruction? If so → antibiotics + urgent drainage.
Is there an organ whose viability is time-dependent? Testicular torsion → urgent surgery. Ischemic priapism → urgent treatment.
Is there an obstruction that needs drainage? Urinary retention → drain the bladder. Retention due to clots → evacuate clots and maintain drainage. Infected urinary obstruction → drain the upper urinary tract.

In urological emergencies, the initial goal is often not to definitively resolve the disease, but to recognize the risk, stabilize the patient, and drain or preserve the organ when appropriate.

Clinical case

Content pending upload Progressive clinical case focused on decision-making.

Self-assessment

Questions pending upload 5–10 multiple-choice questions on this lesson.

References

Links pending upload References to PubMed, DOI, scientific society guidelines and journals.

Testicular torsion