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Testicular torsion is a urological emergency caused by twisting of the spermatic cord, resulting in compromised blood supply to the testis. This condition requires immediate surgical intervention (orchiopexy or orchiectomy) within 6 hours of onset to prevent testicular necrosis and preserve fertility.
The spermatic cord contains the testicular artery, veins, lymphatics, and vas deferens that supply the testis. When torsion occurs, venous outflow is initially compromised followed by arterial inflow obstruction, leading to testicular ischemia and eventual necrosis if not corrected promptly. The condition can be intravaginal (more common in adolescents due to bell-clapper deformity) or extravaginal (more common in neonates).
Diagnosis is primarily clinical, presenting with sudden onset of severe unilateral scrotal pain, often accompanied by nausea and vomiting. Physical examination reveals a high-riding testis with absent cremasteric reflex and negative Prehn's sign (pain relief with testicular elevation). Time is critical as testicular salvage rates decrease significantly after 6 hours, making immediate surgical exploration the priority over imaging studies when clinical suspicion is high.
Key imaging focus: Absent blood flow (torsion), intratesticular mass, hydrocele, epididymal changes