A 20-year-old male presents with sudden severe left testicular pain for 4 hours. Ultrasound Doppler shows absent blood flow to the left testis. What is the standard surgical procedure and the critical time window for testicular salvage?

• A Emergency scrotal exploration, detorsion, and bilateral orchidopexy within 6 hours ✓
• B Manual detorsion only; surgery not required if Doppler flow restored
• C Emergency scrotal exploration within 4 hours; orchiectomy if non-viable, bilateral orchidopexy
• D Conservative management with analgesics and repeat Doppler in 4 hours

Explanation

Testicular torsion is a urological emergency requiring emergency scrotal exploration and detorsion. Bilateral orchidopexy is performed in all cases (viable or not) as the contralateral testis also has Bell-clapper deformity in >80% of cases. Salvage rates: >90% within 6 hours, 50% at 6–12 hours, <10% after 24 hours. The 6-hour window is the critical threshold beyond which ischemic damage is severe. Manual detorsion may be attempted as temporizing measure but must be followed by surgical fixation. Orchidopexy of both testes prevents future torsion.

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

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Written and medically reviewed by the StethoPrep medical team.