Testis torsion: Twisting of the testis – this is a medical emergency. Usually noted at two time periods in life – in the newborn male and in the adolescent male. In the newborn male typically is noted as a hard lump in the scrotum and the patient is usually pain free. In the adolescent male, it is usually associated with the sudden onset of pain that is severe. Development of torsion can lead to compromise in eventual fertility, even if the testis is salvaged.
Evaluation: Immediate emergency evaluation is crucial to prevent loss of the testis. If evaluation and surgical management are delayed beyond 4 hours, the potential to save the testis decreases. The diagnosis may be made on physical examination, and ultrasound is able to confirm that diagnosis. If there is any doubt, immediate surgery is recommended.
Management: In newborn torsion, the testis is usually unable to be saved as there is usually no pain associated with this. Recommended management is to remove the non viable testis and to fix the contralateral testis in place, so as to prevent the catastrophic potential for torsion on the other side.
In the adolescent patient with torsion, immediate surgical management may be able to prevent loss of the testis. Attempts to detorse the testis in the ER are usually not recommended, unless surgical management cannot be carried out immediately. Reduction of the torsion and fixing both testes in the scrotum to prevent recurrence is the recommended surgical management.