A 30-year-old man presents with sudden onset severe right testicular pain. Doppler ultrasound shows absent intratesticular blood flow. Exploratory scrotal surgery at 4 hours from symptom onset reveals a viable testis after detorsion. The correct definitive management is:
- A Bilateral orchidopexy in the same sitting ✓
- B Return the testis and fix only the right side (orchidopexy)
- C Orchidectomy of the affected side due to risk of sympathetic ophthalmia equivalent
- D Unilateral orchidopexy and defer contralateral fixation to an elective setting
Explanation
The bell-clapper deformity responsible for testicular torsion is bilateral in the majority of cases; the contralateral testis has the same anatomical predisposition. Therefore, bilateral orchidopexy (fixation of both testes with non-absorbable sutures to the tunica vaginalis/scrotal wall) is mandatory at the same operation, regardless of which side torted. Failure to fix the contralateral testis exposes the patient to future metachronous torsion. The decision on the affected testis (orchidopexy if viable, orchidectomy if gangrenous) is based on appearance after detorsion.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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Written and medically reviewed by the StethoPrep medical team.