A 28-year-old man presents with acute onset severe left testicular pain and a high-riding transversely lying testis. There is absence of cremasteric reflex on the left side. What is the most important first action?
- A Immediate scrotal exploration without waiting for imaging ✓
- B Colour Doppler ultrasound to confirm absent flow before surgery
- C Urinalysis and MSSU to rule out epididymo-orchitis
- D Serum LDH and AFP to rule out testicular tumour
Correct answer: A. Immediate scrotal exploration without waiting for imaging
Explanation
Testicular torsion is a surgical emergency where time to detorsion critically determines testicular salvage — near-100% viability within 6 hours, dropping to <10% after 24 hours. The clinical diagnosis of torsion (sudden severe pain, high-riding testis, absent cremasteric reflex) should prompt immediate scrotal exploration without waiting for Doppler ultrasound. Delaying for imaging in a high-suspicion clinical scenario risks irreversible ischaemia. Doppler is useful only when the diagnosis is genuinely uncertain.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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Written and medically reviewed by the StethoPrep medical team.