Testicular Torsion in the Emergency Department: Time-Critical Diagnosis and Management

Background: Testicular torsion is a time-critical urologic emergency characterized by twisting of the spermatic cord, leading to compromised blood flow and rapid ischemia. Delay in diagnosis can result in irreversible testicular loss, making early recognition essential.Aim: To review the clinical presentation, diagnostic strategies, and management principles of testicular torsion in the emergency department, emphasizing time-sensitive interventions.Methods: A comprehensive analysis of current emergency practices was conducted, focusing on history, physical examination, imaging modalities, and surgical management. Evidence-based guidelines and validated scoring systems such as TWIST were examined to optimize diagnostic accuracy and expedite care.Results: Testicular viability declines sharply after six hours of ischemia, with salvage rates highest when detorsion occurs early. Doppler ultrasonography demonstrated high sensitivity (≈93%) and specificity (100%) for torsion detection, though clinical judgment remains paramount. Manual detorsion may serve as a temporizing measure when surgical intervention is delayed, but definitive management requires scrotal exploration and bilateral orchiopexy. Neonatal torsion presents unique challenges due to extravaginal mechanisms and limited salvage potential.Conclusion: Testicular torsion demands immediate recognition and surgical intervention to prevent organ loss and preserve fertility. Emergency workflows should prioritize rapid triage, early urologic consultation, and judicious imaging without delaying operative readiness.