Testicular Torsion: A Comprehensive Approach From Diagnosis to Management

Abstract

Testicular torsion is the twisting of the spermatic cord and its contents, representing a surgical emergency that affects 3.8 per 100,000 males under 18 years old annually. This condition accounts for 10% to 15% of acute scrotal diseases in children and results in an orchiectomy rate of 42% among boys undergoing surgery for testicular torsion. Rapid recognition and treatment are essential for testicular salvage, and torsion must be ruled out in all patients presenting with acute scrotum. Testicular torsion is primarily a clinical diagnosis; patients typically present with sudden, severe unilateral scrotal pain accompanied by nausea and vomiting. Physical examination may reveal a high-riding testis with an absent cremasteric reflex. If the history and examination strongly suggest torsion, immediate surgical exploration is indicated and should not be delayed for imaging studies. There is generally a four- to eight-hour window before irreversible ischemic damage occurs. Delays in treatment may lead to reduced fertility or the need for orchiectomy.