A 22-year-old man presents with a 2-day history of sudden onset severe left testicular pain and a high-riding, horizontal-lying testis with absent cremasteric reflex. Ultrasound is equivocal. The correct management is:

• A IV antibiotics for epididymo-orchitis and rescan in 48 hours
• B Manual de-torsion in the emergency room followed by outpatient urology referral
• C Urgent surgical exploration within 6 hours; if torsion confirmed, untwist and orchidopexy bilaterally ✓
• D Reassure and discharge with analgesia; cremasteric reflex absence is common in anxious young men

Explanation

Testicular torsion is a urological emergency. Classical signs include sudden severe testicular pain, high-riding transverse-lying testis, and absent cremasteric reflex. Viability rates are 90–100% if detorsion occurs within 6 hours, dropping to 50% at 12 hours and <10% beyond 24 hours. When clinical suspicion is high, immediate surgical exploration is mandatory even if Doppler ultrasound is equivocal; imaging should never delay surgery. Bilateral orchidopexy is performed at the same sitting to prevent contralateral torsion. Antibiotics alone are inappropriate for a clinical torsion presentation.

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.