Testicular Torsion – Pathophysiology, Presentation, and Emergency Management

Testicular torsion is a time-critical surgical emergency that causes sudden testicular pain and can lead to loss of the testis within hours. Learn how to recognize testicular torsion, distinguish it from epididymo-orchitis and other causes of acute scrotum, and act fast to maximize salvage.

This video explains the anatomy of the testis and spermatic cord, the two main types of torsion (intra-vaginal and extra-vaginal), and the classic bell-clapper deformity that increases risk. You’ll learn typical clinical features—sudden unilateral severe scrotal pain, nausea/vomiting, high-riding or horizontally lying testis, swollen tender hemiscrotum, and absent cremasteric reflex—and how the bedside TWIST (Testicular Workup for Ischemia and Suspected Torsion) score guides risk stratification and management. Understand when Doppler scrotal ultrasound helps (if it won’t delay care) and why imaging should not postpone urgent urology review when suspicion is high.

The video highlights immediate steps: urgent surgical referral, strong analgesia, IV access and fluids, and that definitive care is scrotal exploration with detorsion and bilateral orchidopexy—or orchidectomy if the testis is non-viable. It covers temporary manual detorsion technique (open-book outward rotation) as a stopgap only when surgery is unavailable, plus complications (infarction, atrophy, subfertility, chronic pain, psychological impact).

If you or a patient has acute scrotal pain, treat torsion as the top priority—early recognition and prompt surgical action are crucial to save the testis. Watch now to master signs, risks, and life-saving actions.