Treatment

Imaging

High-resolution ultrasonography with color-flow Doppler and radionuclide imaging are two studies that provide information about testicular blood flow. Most clinicians use these studies to help confirm a clinical diagnosis other than testicular torsion.

The ability to evaluate the testicle and spermatic cord anatomically is an additional advantage of ultrasonography. Coiling of the spermatic cord, indicating testicular torsion, may be detected even when testicular blood flow is normal. Such studies are adjunctive to the clinical evaluation for testicular torsion and are used when that diagnosis is equivocal. If torsion is strongly suspected by history and physical findings, imaging only wastes time when emergent surgical exploration is indicated.

Testicular torsion is a surgical emergency, and all efforts should be aimed at bringing the patient to the operating room as quickly as possible within the limits of surgical and anesthetic safety. Outcomes directly depend on the duration of ischemia; thus, time is of the essence. Time wasted attempting to arrange for imaging studies, laboratory testing, or other diagnostic procedures results in lost testicular tissue (Image 8.3).

Image 8.3 Necrotic testicle secondary to testicular torsion.