A 40-year-old man with testicular torsion and large bilateral spermatoceles

Area of Science:

• Urology
• Emergency Medicine
• Radiology

Background:

• Testicular torsion is uncommon in adults, particularly those over 40.
• Spermatoceles are benign cystic scrotal masses, usually asymptomatic.
• This case presents a rare co-occurrence of testicular torsion and bilateral spermatoceles in an adult male.

Purpose of the Study:

• To report a rare case of testicular torsion in a 40-year-old man with bilateral spermatoceles.
• To emphasize the importance of considering testicular torsion in adult patients presenting with testicular pain, even with pre-existing scrotal pathology.
• To highlight the diagnostic role of color Doppler ultrasound in suspected testicular torsion.

Main Methods:

• A 40-year-old male patient presented with acute testicular pain.
• Color Doppler ultrasound revealed heterogeneous echogenicity and absent vascular flow in the right testis, consistent with torsion, along with bilateral spermatoceles.
• Surgical intervention included resection of spermatoceles and testicular detorsion and orchiopexy.

Main Results:

• The patient underwent successful surgical detorsion and resection of bilateral spermatoceles.
• The right testis was salvaged, although partial atrophy was noted at four months follow-up.
• The left testis remained normal.

Conclusions:

• Testicular torsion should be suspected in adult males presenting with testicular pain, irrespective of co-existing conditions like spermatoceles.
• Patients with spermatoceles should be advised to seek immediate medical attention for any new or worsening testicular pain.
• Early diagnosis and intervention are critical for testicular salvage in cases of torsion.