A 28-year-old man presents with sudden-onset left testicular pain without preceding trauma. Examination reveals a high-riding, transversely oriented testicle. The cremasteric reflex is absent. What is the immediate management?
- A Urgent urologic referral for Doppler ultrasound to confirm torsion
- B Manual detorsion and Doppler ultrasound to confirm
- C Emergency scrotal exploration without delaying for imaging ✓
- D Analgesia and urological review within 24 hours
Explanation
Testicular torsion is a urological emergency requiring immediate scrotal exploration — imaging should not delay surgery when clinical suspicion is high. Testicular salvage rates depend critically on time: >90% if explored within 6 hours, ~50% at 12 hours, and <10% after 24 hours. Clinical features (acute pain, high-riding transverse testicle, absent cremasteric reflex) in the appropriate age group (10-25 years) are sufficient to proceed to emergency exploration, bilateral orchidopexy, and fixation of the contralateral testis prophylactically. Doppler ultrasound should not be obtained if it causes a delay.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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