Torsion of the testicle: a clinical review of 20 cases

Early diagnosis of testicular torsion is absolutely mandatory for salvage of a viable organ. The classical clinical presentation is a boy in the second decade with sudden onset of testicular pain accompanied by testicular tenderness and swelling as well as scrotal erythema and edema. The management is emergency exploration of the testicle with either orchiopexy or orchidectomy, depending upon the viability of the testis. In this series of 20 cases 90% had exploration with a salvage rate of 72%. Torsion of the testicle is in most cases due to a congenital abnormality; therefore contralateral orchiopexy is always done at the time of the exploration of the scrotum. The critical time interval from onset to exploration of the torsion is approximately 10 hours. In addition to the acute clinical entity, chronic torsion of the testis should be considered in all patients with unexplained orchalgia.