Testicular torsion: surgical emergency, diagnosis and orchidopexy | Clinique Omicron<\/title>\n<meta name=\"description\" content=\"Testicular torsion is an absolute surgical emergency causing testicular ischemia. Sudden acute scrotal pain, echo-Doppler, surgical detorsion within 6 hours, and bilateral orchiopexy in Quebec.\">\n<meta name=\"keywords\" content=\"torsion testiculaire, torsion testiculaire urgence, torsion testiculaire traitement, orchidopexie, torsion testiculaire diagnostic, \u00e9cho Doppler torsion testiculaire, douleur scrotale aigu\u00eb, torsion testiculaire enfant, signe de Prehn, torsion testiculaire Qu\u00e9bec\">\n<link rel=\"preconnect\" href=\"https:\/\/fonts.googleapis.com\">\n<link href=\"https:\/\/fonts.googleapis.com\/css2?family=Cinzel:wght@600&family=Poppins:wght@400;500;600;700&display=swap\" rel=\"stylesheet\">\n<style>\n@import url('https:\/\/fonts.googleapis.com\/css2?family=Cinzel:wght@600&family=Poppins:wght@400;500;600;700&display=dump');\n\n.co-wrap * {\n font-family: 'Poppins', sans-serif;\n box-sizing: border-box;\n}\n.co-wrap {\n max-width: 1100px;\n margin: 0 auto;\n padding: 30px 0 60px;\n margin-top: 10px;\n}\n.co-label {\n font-family: 'Cinzel', 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torsion<\/h1>\n<style>.oc-fiche-cta{margin:8px 0 34px;padding:22px 24px;border:1.5px solid rgba(50,60,82,.15);border-left:4px solid #FF611C;border-radius:12px;background:#F4F6F8;font-family:Poppins,sans-serif}.oc-fiche-cta-t{font-size:18px;font-weight:600;color:#323C52;margin:0 0 4px;line-height:1.35}.oc-fiche-cta-x{font-size:15px;color:#4D6577;margin:0 0 14px;line-height:1.55}.oc-fiche-cta-b{display:flex;flex-wrap:wrap;gap:10px}.oc-fiche-cta-b a{display:inline-flex;align-items:center;justify-content:center;min-height:44px;padding:10px 18px;border-radius:8px;font-size:14px;font-weight:600;text-decoration:none;box-sizing:border-box}.oc-fiche-cta-b .oc-p{background:#FF611C;color:#fff}.oc-fiche-cta-b .oc-p:hover{background:#E04E0C}.oc-fiche-cta-b .oc-s{background:#fff;color:#323C52;border:1.5px solid rgba(50,60,82,.25)}@media (max-width:600px){.co-wrap h1{font-size:24px;line-height:1.25;text-transform:none}.oc-fiche-cta{padding:18px 16px}.oc-fiche-cta-b a{flex:1 1 100%}body .co-wrap > .co-table,body .co-wrap > .co-table tbody,body .co-wrap > .co-table tr,body .co-wrap > .co-table td{display:block;width:100%;box-sizing:border-box}body .co-wrap > .co-table{min-width:0;table-layout:auto}body .co-wrap > .co-table thead{display:none}body .co-wrap > .co-table tr{margin:0 0 10px;border:1px solid rgba(77,101,119,.18);border-radius:8px;overflow:hidden}body .co-wrap > .co-table td{padding:9px 12px;border:0}body .co-wrap > .co-table td:first-child{font-weight:600;color:#323C52;background:rgba(77,101,119,.07)}#ocw{transform:scale(.8);transform-origin:bottom right}}<\/style><div class=\"oc-fiche-cta\" data-oc-cta=\"fiche-haut-consult\"><p class=\"oc-fiche-cta-t\">Obtenir un avis adapt\u00e9 \u00e0 votre situation<\/p><p class=\"oc-fiche-cta-x\">Consultation en clinique ou en t\u00e9l\u00e9consultation, partout au Qu\u00e9bec.<\/p><div class=\"oc-fiche-cta-b\"><a class=\"oc-p\" href=\"https:\/\/cliniqueomicron.ca\/rendez-vous\/\">Make an appointment<\/a><a class=\"oc-s\" href=\"https:\/\/cliniqueomicron.ca\/consultation-en-ligne\/\">Consult online<\/a><a class=\"oc-s\" href=\"tel:+15146063350\">514 606-3350<\/a><\/div><\/div>\n\n\n <div class=\"co-intro\">\n Testicular torsion is an absolute urological surgical emergency resulting from the testicle twisting around itself on the spermatic cord\u2014leading to compression and then occlusion of the blood vessels (first the spermatic veins, then the testicular artery) \u2192 progressive testicular ischemia \u2192 irreversible necrosis if not treated within the critical time window. Testicular ischemia progresses particularly rapidly due to the testicular tissue\u2019s low tolerance to hypoxia and intra-albugineal pressure, which exacerbates the vascular compromise. With an incidence of 1 in 4,000 men per year\u2014and a bimodal peak during the neonatal period (extravaginal torsion) and especially during adolescence (12\u201318 years\u2014peak at 13\u201314 years \u2014 most common intravaginal torsion \u2014 testicular torsion represents one of the few urological conditions where the functional prognosis (testicular viability) is directly and entirely determined by the delay in surgical intervention: the testicular salvage rate is 90\u2013100 % if surgical detorsion is performed within 6 hours of the onset of pain, over 50 % between 6 and 12 hours, and less than 10 % after 24 hours. Testicular torsion must be considered and ruled out as an emergency in any case of sudden acute scrotal pain in a young man or adolescent \u2014 without waiting for imaging results if the clinical probability is high \u2014 because time lost waiting for diagnostic confirmation can lead to permanent loss of the testicle.\n <\/div>\n\n <h2>Clinical presentation<\/h2>\n <ul class=\"co-list\">\n <li><strong>Sudden acute scrotal pain (cardinal sign):<\/strong> sudden onset + intense + unilateral + often nocturnal (cremasteric muscle at rest \u2192 torsion facilitated) + irradiation to groin + lower abdomen + flank + frequent nausea + vomiting (vagal reflex) + pain may be intermittent (recurrent spontaneous torsion-detorsion - intermittent torsion)<\/li>\n <li><strong>Physical examination :<\/strong> testicle painful to palpation + ascended (retraction due to shortening of the twisted cord) + horizontalized (\u00abbell-shaped\u00bb transverse position - classic but inconstant) + scrotal swelling + scrotal erythema (late) + contralateral testicle may also be horizontalized if bilateral fixation anomaly (\u00abbell-shaped deformity\u00bb)<\/li>\n <li><strong>Negative in Prehn's sign during torsion:<\/strong> testicular elevation does NOT improve pain in torsion (unlike in epididymitis where elevation relieves - positive Prehn's sign in epididymitis) \u2192 sign of low clinical reliability + do not base surgical decision on this sign alone<\/li>\n <li><strong>Cremasteric reflex:<\/strong> absent on side of torsion (stimulation of inner thigh \u2192 elevation normally of testis on same side) \u2192 sensitivity 99 % for torsion if absent + but moderate specificity<\/li>\n <li><strong>Neonatal torsion (extravaginal):<\/strong> scrotum hard + painless + colored (bluish or black) at birth + poor prognosis for testicle (necrosis already established)<\/li>\n <\/ul>\n\n <h2>Differential diagnosis<\/h2>\n\n <table class=\"co-table\">\n <thead>\n <tr>\n <th>Diagnosis<\/th>\n <th>Clinical clues<\/th>\n <th>Doppler ultrasound<\/th>\n <\/tr>\n <\/thead>\n <tbody>\n <tr>\n <td>Testicular torsion<\/td>\n <td>Brutal onset + adolescent + ascended testicle + absent cremasteric reflex + nausea<\/td>\n <td>Absence or reduction of intra-testicular arterial flow \u2192 surgical emergency<\/td>\n <\/tr>\n <tr>\n <td>Epididymo-orchitis<\/td>\n <td>Gradual onset + adult + fever + pyuria + possible STI (chlamydia + gonorrhea) + positive Prehn's sign (elevation relieves)<\/td>\n <td>Increased arterial flow (reactive hypervascularization of the epididymis)<\/td>\n <\/tr>\n <tr>\n <td>Torsion of the hydatid of Morgagni<\/td>\n <td>Child 7\u201312 years + less intense pain + bluish spot visible through the scrotal skin (\u00abblue dot\u00bb \u2013 pathognomonic) + undescended testicle<\/td>\n <td>Normal testicular flow + hypoechoic avascular nodule at the apex<\/td>\n <\/tr>\n <tr>\n <td>Strangulated inguinal hernia<\/td>\n <td>Irreducible mass in the groin + nausea + vomiting + groin pain + child especially<\/td>\n <td>Intestinal loop in the inguinal canal \u2192 surgical emergency<\/td>\n <\/tr>\n <tr>\n <td>Ourlian orchid<\/td>\n <td>Adolescent + adult + parotitis + fever + late orchitis (3-7 days after parotitis)<\/td>\n <td>Increased flux (inflammatory orchitis)<\/td>\n <\/tr>\n <tr>\n <td>Testicular cancer<\/td>\n <td>Painless hard mass + young adult + may present with pain if torsion on tumor<\/td>\n <td>Heterogeneous mass + abnormal vascularization \u2192 oncologic workup<\/td>\n <\/tr>\n <\/tbody>\n <\/table>\n\n <h2>Diagnostic approach and surgical decision<\/h2>\n <ul class=\"co-list\">\n <li><strong>Fundamental rule:<\/strong> in case of strong clinical suspicion of testicular torsion \u2192 go directly to the operating room WITHOUT waiting for the echo-Doppler + a negative surgical exploration (hydatid torsion + epididymitis) is acceptable + but a missed testicular torsion is an irreversible functional catastrophe<\/li>\n <li><strong>Scrotal Doppler Ultrasound<\/strong> examination of choice if clinical probability is intermediate + or if the picture is atypical \u2192 sensitivity 86-100 % + specificity 97-100 % + shows absence or reduction of intratesticular arterial flow + BUT must not delay surgery if clinical probability is high \u2192 imaging waiting time = minutes of testicular perfusion lost<\/li>\n <li><strong>TWIST score (Testicular Workup for Ischemia and Suspected Torsion):<\/strong> hard testicle = 2 pts + nausea\/vomiting = 1 pt + absence of cremasteric reflex = 1 pt + scrotal swelling = 2 pts + ascended testicle = 1 pt \u2192 score 0-2 = low probability (echo-Doppler) + score 3-4 = intermediate (echo-Doppler) + score \u2265 5 = high probability \u2192 direct surgery without echo<\/li>\n <\/ul>\n\n <h2>Surgical treatment<\/h2>\n <ul class=\"co-list\">\n <li><strong>Emergency scrotal surgery:<\/strong> scrotal incision + opening of vagina + inspection of testicle + assessment of viability (color + bleeding at albuginea incision)<\/li>\n <li><strong>Spermatic cord detorsion<\/strong> rotate testicle in opposite direction to torsion \u2192 restore perfusion \u2192 rewarm + warm compresses \u00d7 10-15 minutes<\/li>\n <li><strong>Bilateral orchiopexy<\/strong> if the testicle is viable \u2192 fixation of the affected testicle + contralateral testicle at 3 points on the albuginea (orchidopexy) \u2192 prevention of recurrence + and contralateral torsion (bilateral fixation anomaly in 70 % of cases)<\/li>\n <li><strong>Orchidectomy:<\/strong> if the testicle is non-viable (black + absence of bleeding) \u2192 removal of the necrotic testicle \u2192 prevent autoimmune reaction against the contralateral testicle (anti-spermatozoa) \u2192 contralateral orchidopexy in the same operative timeframe<\/li>\n <li><strong>Manual detorsion (emergency maneuver pending surgery):<\/strong> outward rotation of testicle (\u00abopening a book\u00bb) \u00d7 1.5 turns \u2192 may transiently restore perfusion + reduce pain + DO NOT replace surgery + DO NOT delay transfer to emergency room to attempt manual detorsion<\/li>\n <\/ul>\n\n <div class=\"co-infobox\">\n <span class=\"ico\">\u2119\ufe0f<\/span>\n <span>The 6-hour rule is absolute in testicular torsion\u2014the testicular salvage rate drops from 90% to less than 10% between 6 and 24 hours. Any adolescent or young man presenting with sudden acute scrotal pain should be transferred immediately to the emergency department without wasting time waiting for the pain to resolve spontaneously, calling the on-call physician, or visiting an outpatient clinic. The diagnosis is surgical\u2014a negative examination is preferable to a lost testicle.<\/span>\n <\/div>\n\n <div class=\"co-urgence\">\n <div class=\"co-urgence-titre\">Absolute surgical emergency \u2014 dial 911<\/div>\n <p>Call 911 or go IMMEDIATELY to the emergency room if intense, sudden, unilateral testicular or scrotal pain appears in a teenager or young man \u2014 especially if accompanied by nausea and vomiting or if the testicle appears to have risen. Do not wait for the pain to pass. Do not consult a primary care clinic \u2014 go directly to the emergency department of a hospital with urological surgery services. Every minute counts: the testicle can be saved if surgery is performed within 6 hours. Clinique Omicron can perform the initial assessment and arrange for urgent transfer to the hospital if necessary. To make an appointment for post-surgical follow-up or a preventive consultation, visit <a href=\"https:\/\/cliniqueomicron.ca\" style=\"color:#c0392b;font-weight:600;text-decoration:none;\">cliniqueomicron.ca<\/a>.<\/p>\n <\/div>\n\n <h2>Consult at Clinique Omicron<\/h2>\n <p>Clinique Omicron's Nurse Practitioners (NPs) recognize the clinical presentation of testicular torsion and immediately transfer to surgical emergency without unnecessary diagnostic delay, assess recurrent intermittent torsions (transient, spontaneously resolving scrotal pain), and refer to urology for elective prophylactic orchiopexy. They provide post-operative follow-up after orchiopexy or orchiectomy and educate adolescents and their families on warning signs requiring immediate urgent consultation. Consultations are available at several service points in Quebec and via telemedicine. To book an appointment, visit <a href=\"https:\/\/cliniqueomicron.ca\" style=\"color:#4D6577;font-weight:600;text-decoration:none;\">cliniqueomicron.ca<\/a>.<\/p>\n\n <p class=\"co-disclaimer\">The content of this page is provided for informational purposes only and does not substitute for the advice of an emergency physician or a urologist. Testicular torsion is an absolute surgical emergency \u2014 every minute of delay reduces the chances of saving the testicle. Never wait for the spontaneous disappearance of sudden acute testicular pain in an adolescent or young man \u2014 go to the emergency room immediately.<\/p>\n\n<\/div>\n<\/body>\n<\/html>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>","protected":false},"excerpt":{"rendered":"<p>Torsion testiculaire : urgence chirurgicale, diagnostic et orchidopexie | Clinique Omicron Urologie & Chirurgie p\u00e9diatrique & M\u00e9decine d’urgence Torsion testiculaire La torsion testiculaire est une urgence chirurgicale urologique absolue r\u00e9sultant de la rotation du testicule sur lui-m\u00eame autour du cordon spermatique \u2014 entra\u00eenant la compression puis l’occlusion des vaisseaux sanguins (veines spermatiques en premier +… <a href=\"https:\/\/cliniqueomicron.ca\/en\/torsion-testiculaire\/\" rel=\"bookmark\">Read More \"<span class=\"screen-reader-text\">Testicular torsion: surgical emergency, diagnosis and orchidopexy | Clinique Omicron<\/span><\/a><\/p>","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"om_disable_all_campaigns":false,"neve_meta_sidebar":"","neve_meta_container":"","neve_meta_enable_content_width":"off","neve_meta_content_width":100,"neve_meta_title_alignment":"","neve_meta_author_avatar":"","neve_post_elements_order":"","neve_meta_disable_header":"","neve_meta_disable_footer":"","neve_meta_disable_title":"","_themeisle_gutenberg_block_has_review":false,"_metasync_otto_title":"Torsion testiculaire | Brossard | Clinique Omicron","_metasync_otto_description":"Torsion testiculaire Torsion testiculaire est une condition m\u00e9dicale qui peut n\u00e9cessiter une \u00e9valuation et un suivi m\u00e9dical appropri\u00e9s. Nos professionnels de...","_metasync_otto_keywords":"torsion testiculaire, Clinique Omicron, clinique m\u00e9dicale Qu\u00e9bec, m\u00e9decin g\u00e9n\u00e9raliste Montr\u00e9al, Qu\u00e9bec","_metasync_otto_og_title":"Torsion Testiculaire | Clinique Omicron Qu\u00e9bec","_metasync_otto_og_description":"Torsion testiculaire Torsion testiculaire est une condition m\u00e9dicale qui peut n\u00e9cessiter une \u00e9valuation et un suivi m\u00e9dical appropri\u00e9s. Nos professionnels de...","_metasync_otto_twitter_title":"Torsion Testiculaire | Clinique Omicron","_metasync_otto_twitter_description":"Torsion testiculaire Torsion testiculaire est une condition m\u00e9dicale qui peut n\u00e9cessiter une \u00e9valuation et un suivi m\u00e9dical appropri\u00e9s. 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\n\t\t\t\t\t\n\n\n\n\nTesticular torsion: surgical emergency, diagnosis and orchidopexy | Clinique Omicron<\/title>\n<meta name=\"description\" content=\"Testicular torsion is an absolute surgical emergency causing testicular ischemia. Sudden acute scrotal pain, echo-Doppler, surgical detorsion within 6 hours, and bilateral orchiopexy in Quebec.\">\n<meta name=\"keywords\" content=\"torsion testiculaire, torsion testiculaire urgence, torsion testiculaire traitement, orchidopexie, torsion testiculaire diagnostic, \u00e9cho Doppler torsion testiculaire, douleur scrotale aigu\u00eb, torsion testiculaire enfant, signe de Prehn, torsion testiculaire Qu\u00e9bec\">\n<link rel=\"preconnect\" href=\"https:\/\/fonts.googleapis.com\">\n<link href=\"https:\/\/fonts.googleapis.com\/css2?family=Cinzel:wght@600&family=Poppins:wght@400;500;600;700&display=swap\" rel=\"stylesheet\">\n<style>\n@import url('https:\/\/fonts.googleapis.com\/css2?family=Cinzel:wght@600&family=Poppins:wght@400;500;600;700&display=dump');\n\n.co-wrap * {\n font-family: 'Poppins', sans-serif;\n box-sizing: border-box;\n}\n.co-wrap {\n max-width: 1100px;\n margin: 0 auto;\n padding: 30px 0 60px;\n margin-top: 10px;\n}\n.co-label {\n font-family: 'Cinzel', 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padding: 14px 18px;\n margin: 18px 0 28px;\n font-size: 14px;\n font-weight: 400;\n color: #4D6577;\n line-height: 1.65;\n}\n.co-infobox .ico {\n font-size: 18px;\n flex-shrink: 0;\n}\n.co-urgence {\n background: #fff8f8;\n border-left: 5px solid #c0392b;\n border-radius: 6px;\n padding: 20px 26px;\n margin: 24px 0 32px;\n}\n.co-urgence .co-urgence-titre {\n font-size: 13px;\n font-weight: 700;\n color: #c0392b;\n letter-spacing: 1.5px;\n text-transform: uppercase;\n margin-bottom: 10px;\n}\n.co-urgence p {\n color: #5a2020;\n font-size: 14px;\n margin: 0 0 10px;\n line-height: 1.7;\n}\n.co-urgence p:last-child {\n margin-bottom: 0;\n}\n.co-disclaimer {\n font-size: 13px;\n color: #8a9aaa;\n font-style: italic;\n border-top: 1px solid rgba(77,101,119,.15);\n padding-top: 24px;\n margin-top: 40px;\n line-height: 1.6;\n}\n<\/style>\n<\/head>\n<body>\n<div class=\"co-wrap\">\n\n <span class=\"co-label\">Urology & Pediatric Surgery & Emergency Medicine<\/span>\n <h1>Testicular torsion<\/h1>\n<style>.oc-fiche-cta{margin:8px 0 34px;padding:22px 24px;border:1.5px solid rgba(50,60,82,.15);border-left:4px solid #FF611C;border-radius:12px;background:#F4F6F8;font-family:Poppins,sans-serif}.oc-fiche-cta-t{font-size:18px;font-weight:600;color:#323C52;margin:0 0 4px;line-height:1.35}.oc-fiche-cta-x{font-size:15px;color:#4D6577;margin:0 0 14px;line-height:1.55}.oc-fiche-cta-b{display:flex;flex-wrap:wrap;gap:10px}.oc-fiche-cta-b a{display:inline-flex;align-items:center;justify-content:center;min-height:44px;padding:10px 18px;border-radius:8px;font-size:14px;font-weight:600;text-decoration:none;box-sizing:border-box}.oc-fiche-cta-b .oc-p{background:#FF611C;color:#fff}.oc-fiche-cta-b .oc-p:hover{background:#E04E0C}.oc-fiche-cta-b .oc-s{background:#fff;color:#323C52;border:1.5px solid rgba(50,60,82,.25)}@media (max-width:600px){.co-wrap h1{font-size:24px;line-height:1.25;text-transform:none}.oc-fiche-cta{padding:18px 16px}.oc-fiche-cta-b a{flex:1 1 100%}body .co-wrap > .co-table,body .co-wrap > .co-table tbody,body .co-wrap > .co-table tr,body .co-wrap > .co-table td{display:block;width:100%;box-sizing:border-box}body .co-wrap > .co-table{min-width:0;table-layout:auto}body .co-wrap > .co-table thead{display:none}body .co-wrap > .co-table tr{margin:0 0 10px;border:1px solid rgba(77,101,119,.18);border-radius:8px;overflow:hidden}body .co-wrap > .co-table td{padding:9px 12px;border:0}body .co-wrap > .co-table td:first-child{font-weight:600;color:#323C52;background:rgba(77,101,119,.07)}#ocw{transform:scale(.8);transform-origin:bottom right}}<\/style><div class=\"oc-fiche-cta\" data-oc-cta=\"fiche-haut-consult\"><p class=\"oc-fiche-cta-t\">Obtenir un avis adapt\u00e9 \u00e0 votre situation<\/p><p class=\"oc-fiche-cta-x\">Consultation en clinique ou en t\u00e9l\u00e9consultation, partout au Qu\u00e9bec.<\/p><div class=\"oc-fiche-cta-b\"><a class=\"oc-p\" href=\"https:\/\/cliniqueomicron.ca\/rendez-vous\/\">Make an appointment<\/a><a class=\"oc-s\" href=\"https:\/\/cliniqueomicron.ca\/consultation-en-ligne\/\">Consult online<\/a><a class=\"oc-s\" href=\"tel:+15146063350\">514 606-3350<\/a><\/div><\/div>\n\n\n <div class=\"co-intro\">\n Testicular torsion is an absolute urological surgical emergency resulting from the testicle twisting around itself on the spermatic cord\u2014leading to compression and then occlusion of the blood vessels (first the spermatic veins, then the testicular artery) \u2192 progressive testicular ischemia \u2192 irreversible necrosis if not treated within the critical time window. Testicular ischemia progresses particularly rapidly due to the testicular tissue\u2019s low tolerance to hypoxia and intra-albugineal pressure, which exacerbates the vascular compromise. With an incidence of 1 in 4,000 men per year\u2014and a bimodal peak during the neonatal period (extravaginal torsion) and especially during adolescence (12\u201318 years\u2014peak at 13\u201314 years \u2014 most common intravaginal torsion \u2014 testicular torsion represents one of the few urological conditions where the functional prognosis (testicular viability) is directly and entirely determined by the delay in surgical intervention: the testicular salvage rate is 90\u2013100 % if surgical detorsion is performed within 6 hours of the onset of pain, over 50 % between 6 and 12 hours, and less than 10 % after 24 hours. Testicular torsion must be considered and ruled out as an emergency in any case of sudden acute scrotal pain in a young man or adolescent \u2014 without waiting for imaging results if the clinical probability is high \u2014 because time lost waiting for diagnostic confirmation can lead to permanent loss of the testicle.\n <\/div>\n\n <h2>Clinical presentation<\/h2>\n <ul class=\"co-list\">\n <li><strong>Sudden acute scrotal pain (cardinal sign):<\/strong> sudden onset + intense + unilateral + often nocturnal (cremasteric muscle at rest \u2192 torsion facilitated) + irradiation to groin + lower abdomen + flank + frequent nausea + vomiting (vagal reflex) + pain may be intermittent (recurrent spontaneous torsion-detorsion - intermittent torsion)<\/li>\n <li><strong>Physical examination :<\/strong> testicle painful to palpation + ascended (retraction due to shortening of the twisted cord) + horizontalized (\u00abbell-shaped\u00bb transverse position - classic but inconstant) + scrotal swelling + scrotal erythema (late) + contralateral testicle may also be horizontalized if bilateral fixation anomaly (\u00abbell-shaped deformity\u00bb)<\/li>\n <li><strong>Negative in Prehn's sign during torsion:<\/strong> testicular elevation does NOT improve pain in torsion (unlike in epididymitis where elevation relieves - positive Prehn's sign in epididymitis) \u2192 sign of low clinical reliability + do not base surgical decision on this sign alone<\/li>\n <li><strong>Cremasteric reflex:<\/strong> absent on side of torsion (stimulation of inner thigh \u2192 elevation normally of testis on same side) \u2192 sensitivity 99 % for torsion if absent + but moderate specificity<\/li>\n <li><strong>Neonatal torsion (extravaginal):<\/strong> scrotum hard + painless + colored (bluish or black) at birth + poor prognosis for testicle (necrosis already established)<\/li>\n <\/ul>\n\n <h2>Differential diagnosis<\/h2>\n\n <table class=\"co-table\">\n <thead>\n <tr>\n <th>Diagnosis<\/th>\n <th>Clinical clues<\/th>\n <th>Doppler ultrasound<\/th>\n <\/tr>\n <\/thead>\n <tbody>\n <tr>\n <td>Testicular torsion<\/td>\n <td>Brutal onset + adolescent + ascended testicle + absent cremasteric reflex + nausea<\/td>\n <td>Absence or reduction of intra-testicular arterial flow \u2192 surgical emergency<\/td>\n <\/tr>\n <tr>\n <td>Epididymo-orchitis<\/td>\n <td>Gradual onset + adult + fever + pyuria + possible STI (chlamydia + gonorrhea) + positive Prehn's sign (elevation relieves)<\/td>\n <td>Increased arterial flow (reactive hypervascularization of the epididymis)<\/td>\n <\/tr>\n <tr>\n <td>Torsion of the hydatid of Morgagni<\/td>\n <td>Child 7\u201312 years + less intense pain + bluish spot visible through the scrotal skin (\u00abblue dot\u00bb \u2013 pathognomonic) + undescended testicle<\/td>\n <td>Normal testicular flow + hypoechoic avascular nodule at the apex<\/td>\n <\/tr>\n <tr>\n <td>Strangulated inguinal hernia<\/td>\n <td>Irreducible mass in the groin + nausea + vomiting + groin pain + child especially<\/td>\n <td>Intestinal loop in the inguinal canal \u2192 surgical emergency<\/td>\n <\/tr>\n <tr>\n <td>Ourlian orchid<\/td>\n <td>Adolescent + adult + parotitis + fever + late orchitis (3-7 days after parotitis)<\/td>\n <td>Increased flux (inflammatory orchitis)<\/td>\n <\/tr>\n <tr>\n <td>Testicular cancer<\/td>\n <td>Painless hard mass + young adult + may present with pain if torsion on tumor<\/td>\n <td>Heterogeneous mass + abnormal vascularization \u2192 oncologic workup<\/td>\n <\/tr>\n <\/tbody>\n <\/table>\n\n <h2>Diagnostic approach and surgical decision<\/h2>\n <ul class=\"co-list\">\n <li><strong>Fundamental rule:<\/strong> in case of strong clinical suspicion of testicular torsion \u2192 go directly to the operating room WITHOUT waiting for the echo-Doppler + a negative surgical exploration (hydatid torsion + epididymitis) is acceptable + but a missed testicular torsion is an irreversible functional catastrophe<\/li>\n <li><strong>Scrotal Doppler Ultrasound<\/strong> examination of choice if clinical probability is intermediate + or if the picture is atypical \u2192 sensitivity 86-100 % + specificity 97-100 % + shows absence or reduction of intratesticular arterial flow + BUT must not delay surgery if clinical probability is high \u2192 imaging waiting time = minutes of testicular perfusion lost<\/li>\n <li><strong>TWIST score (Testicular Workup for Ischemia and Suspected Torsion):<\/strong> hard testicle = 2 pts + nausea\/vomiting = 1 pt + absence of cremasteric reflex = 1 pt + scrotal swelling = 2 pts + ascended testicle = 1 pt \u2192 score 0-2 = low probability (echo-Doppler) + score 3-4 = intermediate (echo-Doppler) + score \u2265 5 = high probability \u2192 direct surgery without echo<\/li>\n <\/ul>\n\n <h2>Surgical treatment<\/h2>\n <ul class=\"co-list\">\n <li><strong>Emergency scrotal surgery:<\/strong> scrotal incision + opening of vagina + inspection of testicle + assessment of viability (color + bleeding at albuginea incision)<\/li>\n <li><strong>Spermatic cord detorsion<\/strong> rotate testicle in opposite direction to torsion \u2192 restore perfusion \u2192 rewarm + warm compresses \u00d7 10-15 minutes<\/li>\n <li><strong>Bilateral orchiopexy<\/strong> if the testicle is viable \u2192 fixation of the affected testicle + contralateral testicle at 3 points on the albuginea (orchidopexy) \u2192 prevention of recurrence + and contralateral torsion (bilateral fixation anomaly in 70 % of cases)<\/li>\n <li><strong>Orchidectomy:<\/strong> if the testicle is non-viable (black + absence of bleeding) \u2192 removal of the necrotic testicle \u2192 prevent autoimmune reaction against the contralateral testicle (anti-spermatozoa) \u2192 contralateral orchidopexy in the same operative timeframe<\/li>\n <li><strong>Manual detorsion (emergency maneuver pending surgery):<\/strong> outward rotation of testicle (\u00abopening a book\u00bb) \u00d7 1.5 turns \u2192 may transiently restore perfusion + reduce pain + DO NOT replace surgery + DO NOT delay transfer to emergency room to attempt manual detorsion<\/li>\n <\/ul>\n\n <div class=\"co-infobox\">\n <span class=\"ico\">\u2119\ufe0f<\/span>\n <span>The 6-hour rule is absolute in testicular torsion\u2014the testicular salvage rate drops from 90% to less than 10% between 6 and 24 hours. Any adolescent or young man presenting with sudden acute scrotal pain should be transferred immediately to the emergency department without wasting time waiting for the pain to resolve spontaneously, calling the on-call physician, or visiting an outpatient clinic. The diagnosis is surgical\u2014a negative examination is preferable to a lost testicle.<\/span>\n <\/div>\n\n <div class=\"co-urgence\">\n <div class=\"co-urgence-titre\">Absolute surgical emergency \u2014 dial 911<\/div>\n <p>Call 911 or go IMMEDIATELY to the emergency room if intense, sudden, unilateral testicular or scrotal pain appears in a teenager or young man \u2014 especially if accompanied by nausea and vomiting or if the testicle appears to have risen. Do not wait for the pain to pass. Do not consult a primary care clinic \u2014 go directly to the emergency department of a hospital with urological surgery services. Every minute counts: the testicle can be saved if surgery is performed within 6 hours. Clinique Omicron can perform the initial assessment and arrange for urgent transfer to the hospital if necessary. To make an appointment for post-surgical follow-up or a preventive consultation, visit <a href=\"https:\/\/cliniqueomicron.ca\" style=\"color:#c0392b;font-weight:600;text-decoration:none;\">cliniqueomicron.ca<\/a>.<\/p>\n <\/div>\n\n <h2>Consult at Clinique Omicron<\/h2>\n <p>Clinique Omicron's Nurse Practitioners (NPs) recognize the clinical presentation of testicular torsion and immediately transfer to surgical emergency without unnecessary diagnostic delay, assess recurrent intermittent torsions (transient, spontaneously resolving scrotal pain), and refer to urology for elective prophylactic orchiopexy. They provide post-operative follow-up after orchiopexy or orchiectomy and educate adolescents and their families on warning signs requiring immediate urgent consultation. Consultations are available at several service points in Quebec and via telemedicine. To book an appointment, visit <a href=\"https:\/\/cliniqueomicron.ca\" style=\"color:#4D6577;font-weight:600;text-decoration:none;\">cliniqueomicron.ca<\/a>.<\/p>\n\n <p class=\"co-disclaimer\">The content of this page is provided for informational purposes only and does not substitute for the advice of an emergency physician or a urologist. Testicular torsion is an absolute surgical emergency \u2014 every minute of delay reduces the chances of saving the testicle. Never wait for the spontaneous disappearance of sudden acute testicular pain in an adolescent or young man \u2014 go to the emergency room immediately.<\/p>\n\n<\/div>\n<\/body>\n<\/html>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>","protected":false},"excerpt":{"rendered":"<p>Torsion testiculaire : urgence chirurgicale, diagnostic et orchidopexie | Clinique Omicron Urologie & Chirurgie p\u00e9diatrique & M\u00e9decine d’urgence Torsion testiculaire La torsion testiculaire est une urgence chirurgicale urologique absolue r\u00e9sultant de la rotation du testicule sur lui-m\u00eame autour du cordon spermatique \u2014 entra\u00eenant la compression puis l’occlusion des vaisseaux sanguins (veines spermatiques en premier +… <a href=\"https:\/\/cliniqueomicron.ca\/en\/torsion-testiculaire\/\" rel=\"bookmark\">Read More \"<span class=\"screen-reader-text\">Testicular torsion: surgical emergency, diagnosis and orchidopexy | Clinique Omicron<\/span><\/a><\/p>","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"om_disable_all_campaigns":false,"neve_meta_sidebar":"","neve_meta_container":"","neve_meta_enable_content_width":"off","neve_meta_content_width":100,"neve_meta_title_alignment":"","neve_meta_author_avatar":"","neve_post_elements_order":"","neve_meta_disable_header":"","neve_meta_disable_footer":"","neve_meta_disable_title":"","_themeisle_gutenberg_block_has_review":false,"_metasync_otto_title":"Torsion testiculaire | Brossard | Clinique Omicron","_metasync_otto_description":"Torsion testiculaire Torsion testiculaire est une condition m\u00e9dicale qui peut n\u00e9cessiter une \u00e9valuation et un suivi m\u00e9dical appropri\u00e9s. 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Nos professionnels de...","rank_math_title":"","rank_math_description":"","_yoast_wpseo_title":"","_yoast_wpseo_metadesc":"","_aioseo_title":"Torsion testiculaire : urgence chirurgicale, diagnostic et orchidopexie | Clinique Omicron","_aioseo_description":"La torsion testiculaire est une urgence chirurgicale absolue avec isch\u00e9mie testiculaire progressive. Douleur scrotale soudaine testicule ascensionn\u00e9 r\u00e9flexe cr\u00e9mast\u00e9rique absent, score TWIST, d\u00e9torsion 6h 90% sauvetage, orchidopexie bilat\u00e9rale au Qu\u00e9bec.","_metasync_seo_title":"Torsion testiculaire | Clinique Omicron","_metasync_seo_desc":"Torsion testiculaire : douleur soudaine et intense du testicule, une urgence chirurgicale. 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