Testicular torsion: Time is the enemy

Background: The acute scrotum is a diagnostic dilemma, and testicular torsi on is of primary interest because of its fertility problems for the patient and medico-legal issues for the surgeon. The present study aimed to correl ate operative findings of patients with suspected testicular torsion with c ertain clinical variables and investigations to see if diagnosis and outcom e could be improved. Methods: A total of 99 patients underwent scrotal exploration for suspected testicular torsion at the Royal Brisbane Hospital between 1990 and 1995. C olour Doppler ultrasound, white blood count and urine microscopy results we re documented, along with the patient's age and duration of testicular pain . Results: Fifty-six patients were found to have torsion, and the testicular loss rate was 23%. Patients who experienced testicular pain For longer than 12 h had a testicular loss rare of 67%. A negative urine microscopy was su ggestive of testicular torsion, but was not diagnostic. The white blood cou nt did not aid in the diagnosis. Colour Doppler ultrasound of the scrotum w as used on nine occasions with three false negative results and a sensitivi ty of only 57%. Conclusions: Time is the enemy when managing the acute scrotum. No investig ation substantially improves clinical diagnosis enough to warrant any delay in definitive surgical intervention.