A 25-year-old man presents with sudden onset severe right scrotal pain for 4 hours, with a high-riding testis and absent cremasteric reflex. Doppler ultrasound is being arranged. What is the MOST critical next step?
- A Immediate surgical exploration without waiting for ultrasound results ✓
- B Complete Doppler ultrasound before any surgical decision
- C Conservative management with analgesia for 12 hours then re-evaluate
- D Urine culture and IV antibiotics for suspected epididymo-orchitis
Correct answer: A. Immediate surgical exploration without waiting for ultrasound results
Explanation
Testicular torsion is a surgical emergency; the clinical presentation here (sudden pain, high-riding testis, absent cremasteric reflex) is highly specific. Testicular salvage rates are >90% if detorsion occurs within 6 hours but fall to <10% beyond 24 hours. Doppler ultrasound should not delay surgery when clinical suspicion is high, as false-negative results can occur and delay is catastrophic. Immediate scrotal exploration with detorsion and bilateral orchidopexy is the treatment.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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Written and medically reviewed by the StethoPrep medical team.