What immediate management steps should be taken in the primary care setting for a patient suspected of having testicular torsion?

Immediate management steps in primary care for suspected testicular torsion:

• Recognise testicular torsion as a urological emergency requiring urgent action.
• Arrange immediate emergency hospital admission for surgical assessment and management without delay. This is critical because testicular torsion requires prompt surgical detorsion and bilateral orchidopexy to preserve testicular viability and fertility.
• Do not delay transfer for imaging or attempt manual detorsion in primary care. Surgical exploration should ideally occur within 4 to 8 hours of symptom onset to prevent permanent ischaemic damage and potential loss of the testicle.
• Provide urgent referral to urology or paediatric surgery depending on the patient’s age and clinical judgement.

These steps prioritise rapid hospital admission and surgical intervention to maximise testicular salvage and reduce the risk of atrophy or orchidectomy.

References: NICE CKS