SAQ 271 – Urology – testicular torsion

Question 6. testicular torsion.

a. Distinguishing features

• Sudden onset of severe, unilateral, constant pain.
• Absence of trauma or urinary symptoms.
• A high-riding or transverse testis.
• Absent cremasteric reflex.
• Nausea or vomiting.
• Pain not relieved by testicular elevation.

b. Ultrasound advantages

• May demonstrate reduced blood flow and support the diagnosis.
• May identify an alternative diagnosis and is non-invasive.

c. Ultrasound disadvantages

• A normal study cannot reliably exclude torsion, particularly if incomplete or intermittent.
• It may delay urgent surgery and is operator dependent.

d. Communication

• Explain the suspected diagnosis and the role or limitations of ultrasound.
• Explain that urgent, time-dependent surgical assessment is required.
• Give a clear timeframe for review and escalation.
• Explain that testicular salvage is not guaranteed and consent will be completed by the surgical team.
• Provide analgesia and ongoing support.