Testicular Torsion Treatment
Immediate urological consultation and prompt surgical exploration is the definitive treatment for suspected testicular torsion, with surgery required within 6-8 hours of symptom onset to prevent permanent testicular loss. 1
Urgent Surgical Management
Surgical exploration and detorsion must be performed within 6-8 hours of symptom onset to prevent permanent ischemic damage, with better outcomes when surgery occurs within 12 hours. 1
Do not delay surgery for imaging if clinical suspicion is high—testicular viability is critically time-dependent, and waiting for confirmatory tests can result in testicular loss. 1
Even when imaging is performed, immediate urological consultation should occur simultaneously rather than sequentially. 1
Risk Stratification Approach
For high clinical suspicion (TWIST score ≥5): proceed directly to surgical exploration without imaging, as the positive predictive value is 92.86% and delays worsen outcomes. 1, 2
For intermediate suspicion (TWIST score 1-5): obtain urgent Duplex Doppler ultrasound while preparing for potential surgery, but do not allow imaging to delay treatment if clinical deterioration occurs. 1
For low suspicion (TWIST score 0): ultrasound can safely rule out torsion with a negative predictive value of 96.61%. 2
Critical Pitfalls to Avoid
False-negative Doppler evaluations can occur with partial torsion or spontaneous detorsion—if clinical suspicion remains high despite normal imaging, proceed to surgical exploration. 1
Atypical presentations exist, including patients presenting with back pain as the primary symptom rather than scrotal pain—always examine the testicles in adolescent males with unexplained pain. 3
In neonatal/perinatal torsion, immediate surgical intervention is recommended even when unilateral torsion is suspected, as bilateral involvement can be missed on physical examination and imaging, and some endocrine function may be retained even in necrotic testes. 4, 5
Surgical Technique
Bilateral orchiopexy should be performed during surgery—the contralateral testicle requires fixation to prevent future torsion. 1
Consider preserving even necrotic-appearing testes when possible, as some endocrine function may be retained. 4, 5
Post-Operative Care
- Bed rest, scrotal elevation, and analgesics should be provided until inflammation subsides. 1