Torsion of testis is an emergency condition where testis rotates in its axis compromising its blood supply. Testicular torsion is most common between 10 and 25 years of age.

Clinical features

1.   Patient presents with sudden onset pain in the scrotum, groin and lower abdomen.

2.   On physical examination, the testis will be swollen, tender, and high-riding, with an abnormal transverse lie.

•           The testis seems high and the tender twisted cord can be palpated above it.

•           The most sensitive physical finding in testicular torsion is the absence of the cremasteric reflex.

•           This reflex is elicited by stroking or pinching the medial thigh, causing contraction of the cremaster muscle, which elevates the testis.

•           The cremasteric reflex is considered positive if the testicle moves at least 0.5 cm.

•           A negative Prehn sign (relief of pain with elevation of the testicle) is classically thought to be a predictor of torsion, this is unreliable for diagnosis

Differential Diagnosis

1.      Epididymo-orchitis

•           In epididymo-orchitis there will usually be dysuria associated with the accompanying   urinary infection.

•           Elevation of the testis reduces the pain in epididymo-orchitis and makes it worse in torsion.

2.      Torsion of Appendage of testis

Investigation

Color Doppler Ultrasound scan will confirm the absence of the blood supply to the affected testis.

•           Non-surgical correction can sometimes be accomplished by manually rotating the testicle in the opposite direction (i.e., outward, towards the thigh) It is based on the assumption that twisting of the testis occurs in a medial direction.

•           The resolution of symptoms after manual detorsion did not correlate with the presence or absence of persistent torsion. This maneuver maybe attempted, but it should not delay transfer to the operating room for definitive detorsion and fixation of the testis.

Management

•           Testicular    torsion   is    a    surgical   emergency   that requires immediate intervention to restore the flow of blood.

•           If treated either manually or surgically within six hours, there is a high chance of preserving the testicle.

•           If there is any doubt about the diagnosis, the scrotum should be explored without delay. Immediately refers to a higher center if facilities are not available.

•           Treatment of torsion of testis requires immediate correction by surgical exploration through scrotal incision, untwisting of the cord and orchiopexy. It is important to fix the opposite testis at the same time.

Patient education

•           Any scrotal swelling should be brought to notice of your doctor.

•           Any sudden onset swelling of the testis merits immediate attention of the surgeon and delay in diagnosis or treatment even for few hours can be harmful.