Pathophysiology
Clinical meaning
Testicular torsion is a surgical emergency in which the spermatic cord twists, cutting off blood supply to the testis. Without intervention within 6 hours, testicular viability drops dramatically: salvage rate is 90-100% within 6 hours but falls to 20% after 12 hours and near 0% after 24 hours. The bell-clapper deformity (abnormally high attachment of the tunica vaginalis allowing the testis to rotate freely within the scrotum) predisposes to torsion and is often bilateral. Peak incidence is bimodal: neonatal period and adolescence (12-18 years). Classic presentation includes sudden onset of severe unilateral scrotal pain, nausea/vomiting, absent cremasteric reflex on the affected side, and a high-riding testis with horizontal lie. Prehn sign is negative (no relief with elevation). Manual detorsion (rotating the testis outward like opening a book) may be attempted as a temporizing measure but does not replace surgical exploration. Bilateral orchiopexy is performed to prevent recurrence on both sides.