Testicular torsion
A time-critical urological emergency in which rotation of the spermatic cord compromises arterial inflow and venous outflow to the testis. Rapid recognition, prompt escalation and urgent surgical management are essential to maximise testicular salvage (RCEM curriculum/RCEMLearning).
Learning outcomes
- Recognise the typical history and examination findings of torsion and distinguish it from common mimics.
- Know that torsion is a surgical emergency: arrange immediate urology/surgical review and prepare the patient for theatre.
- Use Doppler ultrasound selectively - it must never delay definitive assessment and treatment when torsion is likely.
- Understand temporising measures (manual detorsion) and the need for definitive bilateral orchidopexy.
Pathophysiology and epidemiology
- Torsion occurs when the testis and spermatic cord rotate within the tunica vaginalis, kinking the cord and producing ischaemia. The bell‑clapper deformity (high attachment of the tunica vaginalis) is the common anatomical predisposition.
- Degree of rotation and duration of ischaemia determine testicular viability.
- Peak incidence is in adolescence (≈12-18 years) but torsion can occur at any age. Neonatal/perinatal torsion is often antenatal and frequently unsalvageable (NIPE).
Clinical presentation
- Classic presentation is sudden, severe unilateral scrotal pain, often accompanied by nausea and vomiting.
- Pain may be referred to the lower abdomen.