When is it appropriate to refer a patient with suspected testicular torsion to secondary care for surgical intervention?

It is appropriate to refer a patient with suspected testicular torsion to secondary care for surgical intervention when they present with sudden-onset scrotal pain and testicular torsion is suspected clinically ¹. In such cases, an emergency hospital admission to urology or paediatric surgery should be arranged, based on clinical judgement ¹.

Testicular torsion is considered a urological emergency, requiring immediate surgical exploration if suspected ¹. Surgical repair should ideally be performed within 4 hours to salvage the testicle [Crawford, 2014]. There is a critical 4–8 hour window for surgical management before permanent ischaemic damage to the testicle occurs, which could lead to decreased fertility or the need for orchidectomy if the testicle becomes necrotic or non-viable [Sharp, 2013]. Management involves immediate surgical detorsion and bilateral orchidopexy (fixation of the testicle) to help preserve fertility [Sharp, 2013; Jefferies, 2015; RCS, 2016; Radmayr, 2021].

For patients who do not have current scrotal swelling or pain but have a history of previous episodes of severe, self-limiting scrotal pain or swelling (which may indicate spontaneous testicular torsion and detorsion), a urology referral should be arranged ¹. The urgency of this referral depends on the frequency and duration of these episodes, as urological investigation is needed due to the risk of segmental ischaemia from chronic intermittent torsion [Sharp, 2013; Radmayr, 2021].