If testicular torsion is strongly suspected, what is the best next step rather than delaying for imaging?

• A. Schedule a Doppler ultrasound
• B. Observe for several hours
• C. Emergent surgical exploration
• D. Administer broad-spectrum antibiotics

Answer: (C)

Testicular torsion requires rapid action because the testis remains viable only for a limited time after blood flow is cut off. When the clinical picture strongly suggests torsion—sudden, severe scrotal or testicular pain with signs like a high-riding testis and a diminished cremasteric reflex—the priority is to restore blood flow as quickly as possible. Imaging studies, such as Doppler ultrasound, can be helpful in uncertain cases, but they can also delay definitive treatment and may miss torsion in some situations. Emergent surgical exploration allows immediate detorsion and fixation of the affected testis (orchiopexy), and often fixation of the contralateral testis to prevent future torsion. If exploration rules out torsion, other causes can be addressed without delay. Delaying for imaging or observation increases the risk of testicular necrosis and loss of function.