Acute Testicular Pain

Testicular torsion occurs when the spermatic cord rotates and progressively obstructs testicular circulation. Venous outflow is compromised first, causing congestion and swelling; continued rotation then reduces arterial inflow. The resulting ischaemia is worsened when oxygenated blood returns after detorsion, because reperfusion generates oxygen-derived free radicals that can injure tissue beyond the original period of hypoperfusion. Intravaginal torsion is usually enabled by a bell-clapper deformity. The tunica vaginalis attaches high around the testis instead of securing it normally to the scrotal wall, allowing the testis to swing and rotate freely within the sac. This anatomical variant is present in roughly 12% of males and is usually bilateral. Consequently, treatment fixes both testes, not only the painful one. The time course is unforgiving. Irreversible ischaemic change may begin at approximately 4–6 hours. Preservation approaches 100% when detorsion occurs within about 6 hours, falls to roughly 20% beyond 12 hours, and is near zero beyond 24 hours. These figures guide urgency, not eligibility: exploration remains necessary even when the patient presents late, because viability cannot be determined reliably from elapsed time alone and...