A 28-year-old presents with a 3-day history of left testicular pain. Doppler ultrasound shows absent flow to the left testis. On exploration, the testis is found to be twisted 720° with a 'bell-clapper' deformity bilaterally. Following detorsion, the ischaemia-reperfusion assessment at 6 hours from onset shows a dusky blue testis that does not recover its color after warming. What should be done?

• A Orchidopexy of the affected testis and contralateral orchidopexy
• B Orchiectomy of the non-viable testis without contralateral fixation (contralateral anatomy is normal)
• C Salvage the testis with orchidopexy regardless of appearance as ischaemia assessment is unreliable
• D Orchiectomy of the non-viable testis and contralateral orchidopexy ✓

Explanation

When the testis fails to recover its colour, turgor, and bleeding after detorsion and warming (approximately 5 minutes of observation post-detorsion), it is deemed non-viable and orchiectomy is performed to prevent ischaemia-driven antigen release causing autoimmune damage to the contralateral testis. The critical companion procedure is ALWAYS contralateral orchidopexy, because the 'bell-clapper' deformity that predisposes to torsion is bilateral in >80% of cases. Failure to perform contralateral fixation risks contralateral torsion and subsequent infertility. Three-point fixation using non-absorbable sutures is standard. Timing of torsion repair critically affects salvage: >95% at <6 hours, ~50% at 12-24 hours, near zero at >24 hours.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.