Testicular Torsion: The Daily PANCE Blueprint

Home Testicular Torsion: The Daily PANCE Blueprint

Testicular Torsion: The Daily PANCE Blueprint

A 15-year-old boy presents with 2 hours of sudden, severe left testicular pain, nausea, and vomiting that began while playing soccer. The left testis is high-riding with a horizontal lie, exquisitely tender, and the cremasteric reflex is absent. Which of the following is the most appropriate next step?

A. Oral antibiotics and scrotal support
B. Doppler ultrasound before any intervention
C. Urinalysis and observation
D. Reassurance and outpatient urology referral
E. Immediate urologic consultation for surgical exploration and detorsion

Answer and topic summary

The answer is E. Immediate urologic consultation for surgical exploration and detorsion.

Sudden severe testicular pain with a high-riding testis, horizontal lie, and an absent cremasteric reflex is testicular torsion — a surgical emergency with a roughly 6-hour window to save the testis. The next step is immediate urologic consultation for surgical exploration and detorsion (with bilateral orchiopexy); when the diagnosis is clinically clear, surgery must not be delayed for imaging. Doppler ultrasound (showing decreased flow) is used only if it will not delay the operating room. Antibiotics treat epididymitis, a different diagnosis.

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Covered under ⇒ PANCE Blueprint Genitourinary ⇒ Testicular Disorders ⇒ Testicular Torsion

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