Synchronous bilateral testicular torsion in an adult.

Twist and Shout: A Clinical and Experimental Review of Testicular Torsion

“…Other conditions such as epididymoorchitis and torsion of the testicular appendages are also associated with scrotal pain and therefore need to be considered when diagnosing testicular torsion. On physical examination, the hemiscrotum of the affected side is typically swollen, tender, and inflamed, with an absent cremasteric reflex [3], and with pain unrelieved by elevation of the scrotum [4]. The torsed testicle will also be tender, elevated, and may have a horizontal lie.…”

Masturbation inducing synchronous bilateral testicular torsion in an adolescent

“…Unilateral testicular torsion is one of the commonest surgical emergencies occurring in young males, with a calculated annual incidence of 1 in 4000 amongst those aged < 25 years. Subsequent torsion of the unaffected testis occurs in ≈ 2% of individuals [1], but synchronous torsion of both testes is rare, with only a few reported cases and these occurring mainly in the perinatal period [2]. Most cases occur spontaneously, although recent exercise and bicycle riding have been implicated.…”

The Acute, Nontraumatic Scrotum: Assessment, Diagnosis, and Management

“…Any patient with testicular or scrotal pain should be considered to have testicular torsion until proven otherwise. Testicular torsion occurs in neonates and adolescents, but incidence peaks in patients of age 14, with 66% of cases occurring in patients between the ages of 12 and 18 years; however, it may occur at any age (Washowich, 2001).…”

“…Torsion most commonly occurs unilaterally but may be bilateral. Thus, both testicles should be assessed (Washowich, 2001). Palpation will confirm the position; a normal testicle lies in the vertical position, with the epididymis located on the superior pole in the posterolateral position.…”