A 35-year-old man presents with sudden onset left testicular pain and swelling. Ultrasound shows absent blood flow on Doppler. The testis is explored and found viable after detorsion at 4 hours. The Bell clapper deformity found bilaterally. The correct next step is:

• A Left orchiopexy only; right side examined and fixed if bell clapper deformity confirmed
• B Bilateral three-point orchiopexy using non-absorbable sutures ✓
• C Left orchiectomy as any detorsed testis has a 100% atrophy rate
• D Left orchiopexy only; right side does not require surgery if asymptomatic

Explanation

Once testicular torsion is confirmed at exploration and the testis is viable after detorsion, bilateral orchiopexy is mandatory because the bell clapper deformity (high tunica vaginalis attachment allowing free testicular rotation) is bilateral in 40-80% of cases. Both testes must be fixed using a three-point non-absorbable suture technique (fixing testis to tunica vaginalis at three points) to prevent future torsion on either side. Orchiopexy of the affected side alone is insufficient. Orchiectomy is performed only if the testis is non-viable (dusky, no reperfusion after warming and detorsion). Contralateral fixation is always performed regardless of symptoms.

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

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Written and medically reviewed by the StethoPrep medical team.