Chronic Testicular Torsion- the Silent Emasculator

Chronic Testicular Torsion- the Silent Emasculator | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Chronic Testicular Torsion- the Silent Emasculator Snehasis Das, Karthik Kanna Venkatesh This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6536360/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Testicular torsion is recognized as an acute emergency in urology, stemming from either a congenitally elongated mesorchium or excessive tunica vaginalis investment, with trauma being a rare contributing factor. This condition presents with a sudden, painful scrotal swelling. Immediate scrotal ultrasound, supplemented by a duplex scan, is crucial for accurately distinguishing between acute, intermittent, and chronic torsion. This case report presents an atypical instance of unilateral chronic testicular torsion in an adult male, leading to surgical exploration and orchidectomy as part of the management approach. Surgery Critical Care & Emergency Medicine Testicular torsion Surgical Emergency Testis Male reproductive system Figures Figure 1 INTRODUCTION Testicular torsion is among the most prevalent emergencies encountered in casualty departments. It often results from congenital anatomical anomalies such as the bell clapper deformity, which allows the testicular structures to rotate around the vertical axis, precipitating rapid ischemia and potential infarction ( 1 ). As the foremost cause of testicular loss, the annual incidence is approximately 4.5 per 100,000 males, predominantly affecting young males under 25 years of age ( 2 ). Frequently, there are episodes of intermittent pain that necessitate immediate exploration and orchidopexy, optimizing chances of salvaging the testicle within a critical six-hour window. In contrast, chronic torsion can manifest silently, resulting in testicular infarction without warning and consequent tissue loss. This presentation may often masquerade as orchialgia, leading to misdiagnoses such as acute epididymitis. Reports of chronic testicular torsion in adults are exceedingly rare. Here, we present a pioneering case. CASE REPORT An 18-year-old male patient with no significant medical history presented with a sudden onset of right scrotal pain lasting seven days, accompanied by unilateral swelling and mild febrile episodes during the initial phase. The pain, initially sharp and localized to the right inguinoscrotal area, subsided by the third day and transformed into a mild, dull ache. It was non-radiating and aggravated by movement or manual manipulation. The swelling coincided with the pain and exhibited a similar waxing and waning pattern. Initially evaluated at an external facility, he was diagnosed with right epididymorchitis based on clinical findings and managed conservatively. Due to persistent symptoms, he was subsequently referred to our specialized center. On admission, the patient was conscious, oriented, and afebrile, with stable vital signs and no indications of pallor, edema, or lymphadenopathy. Systemic examination revealed no abnormalities, while local examination indicated mild tenderness and swelling of the right testis, which was positioned higher than the left. No thickening or tenderness of the spermatic cord was noted, and regional lymph nodes were unremarkable. Routine laboratory tests revealed mild leukocytosis, with total hemoglobin at 13.5 g/dL, total white blood cell count within normal limits, and platelets at 490,000, with no significant neutrophilia. Serum electrolytes were normal, with urea at 15 mg/dL and creatinine at 0.73 mg/dL, while chest x-ray results were within normal limits. An ultrasound of the scrotum showed an irregular, wedge-shaped hypoechoic area measuring 4 x 3 mm at the mid-portion of the right testis, suggestive of infarction. Additionally, the right epididymis appeared enlarged and edematous, with internal anechoic and hyperechoic areas devoid of vascularity. Conversely, color flow analysis revealed twisted vascular structures at the scrotal root but no distal color flow, with normal findings in the left side counterparts, indicating chronic right testicular torsion with mid-testicular infarction. The patient underwent emergency surgical intervention, revealing a gangrenous right testis with bell clapper deformity, the necrosis extending along the spermatic cord by 1–2 cm (Fig. 1). A right orchidectomy and left orchidopexy were performed. The patient remained stable post-operatively and was discharged two days later. Intraoperative biopsy revealed coagulative necrosis of seminiferous tubules with extensive hemorrhagic areas, while spermatic cord samples showed intact vas deferens with associated blood vessels and nerve structures. DISCUSSION INCIDENCE: Testicular torsion constitutes one of the most common emergencies witnessed in both neonatal and urological settings, exhibiting an annual incidence of 4.5 per 100,000 males, primarily affecting individuals under the age of 25 (2). This condition does not discriminate by age, with the highest incidence rates evident in the first two to three decades of life. The incidence is seen to be the same for both the testis. In addition, any patient who suffers from an acute episode of torsion, 50 % of them are seen to have suffered similar testicular pain prior to the episode of concern (3). PATHOPHYSIOLOGY: - The propensity for testicular torsion is often attributed to certain anatomical factors. The typical presentation involves a horizontally oriented testis rather than the normal vertical alignment, which can occur due to abnormal attachments of the testicle to the scrotal wall or a high-positioned tunica vaginalis, leading to the characteristic bell clapper deformity. Our case also demonstrated this deformity upon testicular examination. Notably, an elongated mesorchium and a lack of firm posterior attachment of the tunica vaginalis significantly contribute to the occurrence of torsion. Furthermore, depending on the axis of rotation, torsions can be classified as intravaginal or extravaginal. Recurrent episodes of intermittent testicular pain preceding a complete torsion can cause progressive, irreversible ischemic damage to testicular tissues if the condition persists beyond six hours. Histological examination typically reveals necrotic or atrophic seminiferous tubules along with areas of infarction and peritubular fibrosis. CLINICAL FEATURES: - Acute torsion episodes typically manifest as sharp testicular pain accompanied by localized swelling and warmth. These symptoms primarily arise from venous congestion and arterial insufficiency, necessitating prompt diagnosis and immediate surgical intervention to relieve the torsion. In contrast, chronic testicular torsion presents as a dull, aching pain on the affected side, often indicating ongoing cell death, with a history of previous subclinical events. DIAGNOSIS: - Testicular torsion is primarily diagnosed through clinical observations, such as a high-riding testis or twisted cord structures. Radiological assessments, particularly ultrasound, can further support the diagnosis, revealing altered echogenicity and twisting of the cord structures, with a color Doppler scan indicating reduced blood flow to the affected testicle. However, some experts advise against scrotal ultrasound in suspected torsion cases due to a 10% false-negative rate, which may lead to delays in surgical intervention and potential testicular loss. TREATMENT: - Chronic testicular torsion often stems from unresolved intermittent torsion, a phenomenon that remains poorly understood. The critical time frame for tissue viability is estimated to be approximately six hours. The likelihood of salvaging the affected testicle is significantly high, ranging from 90-100% if treatment is administered within six hours of pain onset, decreasing to 20-50% within six to twelve hours, and plummeting to a mere 0-10% if treatment is delayed beyond twelve hours. Emergency surgical scrotal exploration is the standard treatment approach. Upon access, a trial of high-flow 100% oxygenation is administered to assess any improvement in the testicular coloration. Typically, the affected testis appears engorged and congested due to arterial insufficiency; if derotation does not restore blood flow, a small incision in the testicular parenchyma is made to evaluate for active bleeding indicative of viable circulation. In the absence of such circulation, orchidectomy of the affected testis is performed. Upon managing the affected side, orchidopexy is conducted on the contralateral side to mitigate the risk of future torsion. Hayn et al. (5) demonstrated complete testicular preservation and significant pain relief following bilateral testicular fixation in cases of intermittent testicular torsion in boys, which is frequently regarded as a trigger for chronic testicular torsion. Similarly, Eaton et al. (3) reported a 97% absolute resolution of symptoms within an average follow-up period of 7.9 months. In the current case, we identified chronic testicular torsion, which during scrotal exploration revealed an infarcted affected testis due to extravaginal torsion, with no signs of vitality, necessitating orchidectomy. Prophylactic orchidopexy was also performed on the contralateral testis. Given that most of these patients are young males, the loss of a testis can lead to significant psychological distress. Moreover, incidents resulting in any permanent sexual dysfunction are rarely documented. Typically, patients develop normally functioning contralateral testicular and sexual capabilities. Therefore, comprehensive post-operative counseling regarding potential impacts on sexual health is essential. CONCLUSION Testicular torsions present intricate clinical scenarios with multifactorial causes. They typically manifest as acute conditions or as self-resolving episodes of intermittent scrotal pain, demanding a high degree of suspicion from clinicians, particularly in patients under 20 years of age. This case underscores the occurrence of chronicity in this diagnosis in adults and reinforces its inclusion in differential diagnoses for cases of non-resolving intermittent scrotal pain. A critical time frame of 6 to 10 hours is vital for maintaining testicular viability; thus, immediate surgical intervention is imperative in all instances. A thorough and detailed history, coupled with a targeted clinical examination, is essential for accurate diagnosis and subsequent enhancement of testicular salvage rates. Declarations DECLARATION OF PATIENT CONSENT : - The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for his/ her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. FINANCIAL SUPPORT AND SPONSORSHIP : - Nil. CONFLICTS OF INTEREST: - There are no conflicts of interest. Disclaimers: All images and case details are available with the authors of this case report Sources of support: There was no source of support Conflict of Interest: No authors have any conflict of interest regarding this case report Patient Consent: The authors of this article have received and archived written patient consent References Schulsinger D, Glassberg K, Strashun A: Intermittent torsion. Association with horizontal lie of the testicle. J Urol 1991;145:1053– 1055. Lee SM, Huh JS, Baek M, et al: A nationwide epidemiological study of testicular torsion in Korea. J Korean Med Sci 2014;29:1684–1687 Eaton SH, Cendron MA, Estrada CR, et al:Intermittent testicular torsion: diagnosticfeatures and management outcomes. J Urol 2005; 174: 1532–1535. Zini L, Mouton D, Leroy X, et al: Should scro-tal ultrasound be discouraged in cases of sus-pected spermatic cord torsion? Prog Urol 2003; 13: 440–444. Hayn MH, Herz DB, Bellinger MF, et al: In-termittent torsion of the spermatic cord por-tends an increased risk of acute testicular in-farction. J Urol 2008; 180(suppl 4):1729–1732. Johnston BI, Wiener JS: Intermittent testicu-lar torsion. BJU Int 2005; 95: 933–934. Additional Declarations The authors declare no competing interests. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6536360","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":448433256,"identity":"b5485731-03ad-4adc-944c-49cd19cd2fd7","order_by":0,"name":"Snehasis Das","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA3klEQVRIiWNgGAWjYJCCA2CSmYHxAZDi4SNFC7MBSAsbKbaxSYBJQsr4xc4ePPilplbevJ33WOXXHDsZNgbmh49u4NEiOTsv4bDMseOGcw7zpd2W3ZYMdBibsXEOHi0Gt3MMDkuwHWOcwcxjdltyGzNQCw+bNGEt/47Zg7QUS26rJ07LwY9tNYkgLYwftx0mrEVyNtAWxr4DyUAtxtKM247zsDET8Au/dI7xxx/f6mxn8J8x/PhzW7U9P3vzw8f4tIAAMw/DYRgDRBJQDgKMPxjqYIxRMApGwSgYBZgAAOYoRGUgOI/oAAAAAElFTkSuQmCC","orcid":"https://orcid.org/0000-0001-7297-462X","institution":"Jawaharlal Institute of Postgraduate Medical Education and Research","correspondingAuthor":true,"prefix":"","firstName":"Snehasis","middleName":"","lastName":"Das","suffix":""},{"id":448433257,"identity":"cd10b5f4-3af5-4bcd-8d0f-bde10825ea57","order_by":1,"name":"Karthik Kanna Venkatesh","email":"","orcid":"https://orcid.org/0009-0008-3210-9787","institution":"Jawaharlal Institute of Postgraduate Medical Education and Research","correspondingAuthor":false,"prefix":"","firstName":"Karthik","middleName":"Kanna","lastName":"Venkatesh","suffix":""}],"badges":[],"createdAt":"2025-04-26 17:28:07","currentVersionCode":1,"declarations":{"humanSubjects":true,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":true,"humanSubjectConsent":true,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":true,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-6536360/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6536360/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":81953048,"identity":"5672aab6-1c7e-4cdb-b25a-8dd68921fe30","added_by":"auto","created_at":"2025-05-05 09:38:15","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":180112,"visible":true,"origin":"","legend":"\u003cp\u003eIntra-operative image- black arrow pointing towards the gangrenous right testis with bell clapper deformity and no active bleeding (indicating nearly complete necrosis of the right testis)\u003c/p\u003e","description":"","filename":"Figure1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-6536360/v1/60f2fb97e3575c8f95ba13f9.jpeg"},{"id":81954878,"identity":"21525fc0-530c-420a-b70e-d8c823de0205","added_by":"auto","created_at":"2025-05-05 09:46:19","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":432460,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6536360/v1/1a9a5055-6a81-4b32-a120-9b2ae6ce62f5.pdf"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003e\u003cstrong\u003eChronic Testicular Torsion- the Silent Emasculator\u003c/strong\u003e\u003c/p\u003e","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eTesticular torsion is among the most prevalent emergencies encountered in casualty departments. It often results from congenital anatomical anomalies such as the bell clapper deformity, which allows the testicular structures to rotate around the vertical axis, precipitating rapid ischemia and potential infarction (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). As the foremost cause of testicular loss, the annual incidence is approximately 4.5 per 100,000 males, predominantly affecting young males under 25 years of age (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Frequently, there are episodes of intermittent pain that necessitate immediate exploration and orchidopexy, optimizing chances of salvaging the testicle within a critical six-hour window. In contrast, chronic torsion can manifest silently, resulting in testicular infarction without warning and consequent tissue loss. This presentation may often masquerade as orchialgia, leading to misdiagnoses such as acute epididymitis. Reports of chronic testicular torsion in adults are exceedingly rare. Here, we present a pioneering case.\u003c/p\u003e"},{"header":"CASE REPORT","content":"\u003cp\u003eAn 18-year-old male patient with no significant medical history presented with a sudden onset of right scrotal pain lasting seven days, accompanied by unilateral swelling and mild febrile episodes during the initial phase. The pain, initially sharp and localized to the right inguinoscrotal area, subsided by the third day and transformed into a mild, dull ache. It was non-radiating and aggravated by movement or manual manipulation. The swelling coincided with the pain and exhibited a similar waxing and waning pattern. Initially evaluated at an external facility, he was diagnosed with right epididymorchitis based on clinical findings and managed conservatively. Due to persistent symptoms, he was subsequently referred to our specialized center.\u003c/p\u003e \u003cp\u003eOn admission, the patient was conscious, oriented, and afebrile, with stable vital signs and no indications of pallor, edema, or lymphadenopathy. Systemic examination revealed no abnormalities, while local examination indicated mild tenderness and swelling of the right testis, which was positioned higher than the left. No thickening or tenderness of the spermatic cord was noted, and regional lymph nodes were unremarkable.\u003c/p\u003e \u003cp\u003eRoutine laboratory tests revealed mild leukocytosis, with total hemoglobin at 13.5 g/dL, total white blood cell count within normal limits, and platelets at 490,000, with no significant neutrophilia. Serum electrolytes were normal, with urea at 15 mg/dL and creatinine at 0.73 mg/dL, while chest x-ray results were within normal limits.\u003c/p\u003e \u003cp\u003eAn ultrasound of the scrotum showed an irregular, wedge-shaped hypoechoic area measuring 4 x 3 mm at the mid-portion of the right testis, suggestive of infarction. Additionally, the right epididymis appeared enlarged and edematous, with internal anechoic and hyperechoic areas devoid of vascularity. Conversely, color flow analysis revealed twisted vascular structures at the scrotal root but no distal color flow, with normal findings in the left side counterparts, indicating chronic right testicular torsion with mid-testicular infarction.\u003c/p\u003e \u003cp\u003eThe patient underwent emergency surgical intervention, revealing a gangrenous right testis with bell clapper deformity, the necrosis extending along the spermatic cord by 1\u0026ndash;2 cm (Fig.\u0026nbsp;1). A right orchidectomy and left orchidopexy were performed. The patient remained stable post-operatively and was discharged two days later. Intraoperative biopsy revealed coagulative necrosis of seminiferous tubules with extensive hemorrhagic areas, while spermatic cord samples showed intact vas deferens with associated blood vessels and nerve structures.\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eINCIDENCE:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTesticular torsion constitutes one of the most common emergencies witnessed in both neonatal and urological settings, exhibiting an annual incidence of 4.5 per 100,000 males, primarily affecting individuals under the age of 25 (2). This condition does not discriminate by age, with the highest incidence rates evident in the first two to three decades of life. The incidence is seen to be the same for both the testis. In addition, any patient who suffers from an acute episode of torsion, 50 % of them are seen to have suffered similar testicular pain prior to the episode of concern (3).\u003c/p\u003e\n\u003cp\u003ePATHOPHYSIOLOGY: -\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe propensity for testicular torsion is often attributed to certain anatomical factors. The typical presentation involves a horizontally oriented testis rather than the normal vertical alignment, which can occur due to abnormal attachments of the testicle to the scrotal wall or a high-positioned tunica vaginalis, leading to the characteristic bell clapper deformity. Our case also demonstrated this deformity upon testicular examination. Notably, an elongated mesorchium and a lack of firm posterior attachment of the tunica vaginalis significantly contribute to the occurrence of torsion. Furthermore, depending on the axis of rotation, torsions can be classified as intravaginal or extravaginal. Recurrent episodes of intermittent testicular pain preceding a complete torsion can cause progressive, irreversible ischemic damage to testicular tissues if the condition persists beyond six hours. Histological examination typically reveals necrotic or atrophic seminiferous tubules along with areas of infarction and peritubular fibrosis.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eCLINICAL FEATURES: - \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAcute torsion episodes typically manifest as sharp testicular pain accompanied by localized swelling and warmth. These symptoms primarily arise from venous congestion and arterial insufficiency, necessitating prompt diagnosis and immediate surgical intervention to relieve the torsion. In contrast, chronic testicular torsion presents as a dull, aching pain on the affected side, often indicating ongoing cell death, with a history of previous subclinical events.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eDIAGNOSIS: - \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTesticular torsion is primarily diagnosed through clinical observations, such as a high-riding testis or twisted cord structures. Radiological assessments, particularly ultrasound, can further support the diagnosis, revealing altered echogenicity and twisting of the cord structures, with a color Doppler scan indicating reduced blood flow to the affected testicle. However, some experts advise against scrotal ultrasound in suspected torsion cases due to a 10% false-negative rate, which may lead to delays in surgical intervention and potential testicular loss.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTREATMENT: - \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eChronic testicular torsion often stems from unresolved intermittent torsion, a phenomenon that remains poorly understood. The critical time frame for tissue viability is estimated to be approximately six hours. The likelihood of salvaging the affected testicle is significantly high, ranging from 90-100% if treatment is administered within six hours of pain onset, decreasing to 20-50% within six to twelve hours, and plummeting to a mere 0-10% if treatment is delayed beyond twelve hours.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eEmergency surgical scrotal exploration is the standard treatment approach. Upon access, a trial of high-flow 100% oxygenation is administered to assess any improvement in the testicular coloration. Typically, the affected testis appears engorged and congested due to arterial insufficiency; if derotation does not restore blood flow, a small incision in the testicular parenchyma is made to evaluate for active bleeding indicative of viable circulation. In the absence of such circulation, orchidectomy of the affected testis is performed. Upon managing the affected side, orchidopexy is conducted on the contralateral side to mitigate the risk of future torsion.\u003c/p\u003e\n\u003cp\u003eHayn et al. (5) demonstrated complete testicular preservation and significant pain relief following bilateral testicular fixation in cases of intermittent testicular torsion in boys, which is frequently regarded as a trigger for chronic testicular torsion. Similarly, Eaton et al. (3) reported a 97% absolute resolution of symptoms within an average follow-up period of 7.9 months.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn the current case, we identified chronic testicular torsion, which during scrotal exploration revealed an infarcted affected testis due to extravaginal torsion, with no signs of vitality, necessitating orchidectomy. Prophylactic orchidopexy was also performed on the contralateral testis. Given that most of these patients are young males, the loss of a testis can lead to significant psychological distress. Moreover, incidents resulting in any permanent sexual dysfunction are rarely documented. Typically, patients develop normally functioning contralateral testicular and sexual capabilities. Therefore, comprehensive post-operative counseling regarding potential impacts on sexual health is essential.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eTesticular torsions present intricate clinical scenarios with multifactorial causes. They typically manifest as acute conditions or as self-resolving episodes of intermittent scrotal pain, demanding a high degree of suspicion from clinicians, particularly in patients under 20 years of age. This case underscores the occurrence of chronicity in this diagnosis in adults and reinforces its inclusion in differential diagnoses for cases of non-resolving intermittent scrotal pain. A critical time frame of 6 to 10 hours is vital for maintaining testicular viability; thus, immediate surgical intervention is imperative in all instances. A thorough and detailed history, coupled with a targeted clinical examination, is essential for accurate diagnosis and subsequent enhancement of testicular salvage rates.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eDECLARATION OF PATIENT CONSENT\u003c/strong\u003e: -\u003c/p\u003e\n\u003cp\u003eThe authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for his/ her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFINANCIAL SUPPORT AND SPONSORSHIP\u003c/strong\u003e: - Nil.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCONFLICTS OF INTEREST:\u003c/strong\u003e -\u0026nbsp;There are no conflicts of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDisclaimers:\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eAll images and case details are available with the authors of this case report\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSources of support:\u003c/strong\u003e There was no source of support\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of Interest:\u003c/strong\u003e No authors have any conflict of interest regarding this case report\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePatient Consent:\u003c/strong\u003e The authors of this article have received and archived written patient consent\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eSchulsinger D, Glassberg K, Strashun A: Intermittent torsion. Association with horizontal lie of the testicle. J Urol 1991;145:1053\u0026ndash; 1055.\u003c/li\u003e\n \u003cli\u003eLee SM, Huh JS, Baek M, et al: A nationwide epidemiological study of testicular torsion in Korea. J Korean Med Sci 2014;29:1684\u0026ndash;1687\u003c/li\u003e\n \u003cli\u003eEaton SH, Cendron MA, Estrada CR, et al:Intermittent testicular torsion: diagnosticfeatures and management outcomes. J Urol 2005; 174: 1532\u0026ndash;1535.\u003c/li\u003e\n \u003cli\u003eZini L, Mouton D, Leroy X, et al: Should scro-tal ultrasound be discouraged in cases of sus-pected spermatic cord torsion? Prog Urol 2003; 13: 440\u0026ndash;444.\u003c/li\u003e\n \u003cli\u003eHayn MH, Herz DB, Bellinger MF, et al: In-termittent torsion of the spermatic cord por-tends an increased risk of acute testicular in-farction. J Urol 2008; 180(suppl 4):1729\u0026ndash;1732.\u003c/li\u003e\n \u003cli\u003eJohnston BI, Wiener JS: Intermittent testicu-lar torsion. BJU Int 2005; 95: 933\u0026ndash;934.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"Jawaharlal Institute of Post Graduate Medical Education and Research","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Testicular torsion, Surgical Emergency, Testis, Male reproductive system","lastPublishedDoi":"10.21203/rs.3.rs-6536360/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6536360/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eTesticular torsion is recognized as an acute emergency in urology, stemming from either a congenitally elongated mesorchium or excessive tunica vaginalis investment, with trauma being a rare contributing factor. This condition presents with a sudden, painful scrotal swelling. Immediate scrotal ultrasound, supplemented by a duplex scan, is crucial for accurately distinguishing between acute, intermittent, and chronic torsion. This case report presents an atypical instance of unilateral chronic testicular torsion in an adult male, leading to surgical exploration and orchidectomy as part of the management approach.\u003c/p\u003e","manuscriptTitle":"Chronic Testicular Torsion- the Silent Emasculator","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-05 09:38:10","doi":"10.21203/rs.3.rs-6536360/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"365ecfa9-53f7-4c2d-b6fc-c6a3a1d05bce","owner":[],"postedDate":"May 5th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":47823142,"name":"Surgery"},{"id":47823143,"name":"Critical Care \u0026 Emergency Medicine"}],"tags":[],"updatedAt":"2025-05-05T09:38:10+00:00","versionOfRecord":[],"versionCreatedAt":"2025-05-05 09:38:10","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6536360","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6536360","identity":"rs-6536360","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}