Testicular torsion is a urological emergency
- Typically in teenage boys, but can occur at any age
- Acute/sudden onset of unilateral testicular pain
- Often triggered by activity (e.g. playing sports)
- “6 hour window” after onset before damage from ischaemia is irreversible
- Major complication is subfertility / infertility
Examination
- Acutely tender testicle (often difficult to examine due to extent of tenderness)
- Firm testicle
- Absent cremasteric reflex
- Abnormal lie
- Horizontal lie
- Rotated so that epididymis is not in normal posterior position
- Elevated (retracted) testicle
“Bell-clapper Deformity”
- Normally the testicle is fixed posteriorly to the tunica vaginalis
- Bell-clapper deformity is where this fixation is absent
- Allows testicle to rotate within tunica
- As it rotates it twists the vessels and cuts of its blood supply
Management
- Urgent urology assessment
- Immediate surgical scrotal exploration
- Untwist the testicle
- Both testicles are fixed in correct position to prevent further episodes (orchiplexy)
- Possible orchiectomy if delayed surgery / necrotic testicle present
