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Testicular Torsion Time Window — RACP Adult Medicine MCQ

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EasyEmergency MedicineTesticular Torsion Time WindowRACP Adult Medicine

A 42-year-old man develops sudden onset severe testicular pain with nausea and vomiting. Examination shows a high-riding left testicle with horizontal lie and an absent cremasteric reflex. Colour Doppler ultrasound shows absent blood flow to the left testicle. The duration of symptoms is 5 hours. What is the most critical time-dependent factor for testicular salvage?

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Correct answer: B — Time to pain relief

Testicular torsion requires surgical exploration and detorsion as an emergency. The salvage rate is: >90% if detorsed within 6 hours, ~50% at 12 hours, and <10% beyond 24 hours. With a 5-hour symptom duration, immediate surgical intervention offers the best chance of testicular salvage. Key principle: if clinical suspicion is high, do NOT delay surgery to obtain imaging – take the patient directly to theatre. Manual detorsion (rotating the testicle outward – 'opening the book') may be attempted as a temporising measure while arranging surgery but should NOT replace surgical exploration and bilateral orchidopexy.

Reference: eTG – 2025 – Urology