What is the immediate treatment for suspected testicular torsion?

Immediate Treatment for Suspected Testicular Torsion

Suspected testicular torsion is a surgical emergency requiring immediate urological consultation and surgical exploration without delay, as testicular viability is compromised within 4-8 hours of onset. 1

Clinical Presentation and Diagnosis

Testicular torsion typically presents with:

• Sudden onset of severe unilateral scrotal pain
• Nausea and vomiting
• Red, swollen scrotum
• High-riding testicle
• Absent cremasteric reflex
• Symptoms often occur without history of trauma 2, 1

Key differential features from epididymitis:

• Torsion: Sudden onset, no relief with elevation, absent cremasteric reflex
• Epididymitis: Gradual onset, relief with elevation (positive Prehn sign), present cremasteric reflex 3

Emergency Management Algorithm

1. Immediate surgical consultation

   • Do not delay for imaging studies if clinical suspicion is high 1
   • Testicular viability decreases significantly after 4-8 hours of ischemia 1

2. While awaiting surgical consultation:

   • Manual detorsion attempt may be performed by rotating the testicle outward (like opening a book) 2
   • This is a temporizing measure only and does not eliminate the need for surgery

3. Surgical exploration

   • Indicated even if symptoms resolve with manual detorsion
   • Involves detorsion, assessment of testicular viability, and bilateral orchidopexy 4
   • Orchiectomy if testis is non-viable (42% of cases) 1

Imaging Considerations

• Do not delay surgical exploration for imaging if clinical suspicion is high 1
• If diagnosis is equivocal or delayed presentation:
  • Color Doppler ultrasound: Shows decreased or absent blood flow in affected testicle 2
  • Radionuclide testicular scintigraphy: May be helpful beyond 12 hours 2

Special Considerations

• Trauma can induce testicular torsion, so torsion must be included in the differential diagnosis of direct testicular trauma 5
• Bilateral torsion can occur, though rare, and requires immediate intervention 6
• Contralateral prophylactic orchidopexy is standard practice during surgical exploration 4

Complications of Delayed Treatment

• Testicular atrophy (9.1-47.5% of cases) 4
• Decreased fertility
• Need for orchiectomy
• Chronic scrotal pain 3

Remember that testicular torsion is primarily a clinical diagnosis, and if suspected, immediate surgical exploration is warranted without waiting for confirmatory tests, as time to treatment directly correlates with testicular salvage rates.