Question

What is NOT true about torsion of the testes?

• A. Absence of flow on Doppler clinches diagnosis
• B. Presence of pyuria assists the diagnosis
• C. The opposite side testis should be fixed
• D. Raising the testis worsens the pain

Hint:

Pyuria points away from torsion, not toward it, since torsion is a vascular, not infective, problem.

Answer 1

The Correct Option is B

Step 1: Understand the question format again.
This is another NOT true question about testicular torsion, so three statements are accurate and one is the false one we need to pick.

Step 2: Recall the basics of testicular torsion.
Torsion happens when the testis twists on its spermatic cord, cutting off its own blood supply. It is a surgical emergency, since the testis can become non viable within a few hours if not untwisted.

Step 3: Check the Doppler statement.
Option A says absent flow on Doppler ultrasound clinches the diagnosis. This is true, colour Doppler showing no blood flow to the testis in a patient with sudden severe scrotal pain is strong evidence of torsion, though a clinically obvious torsion should not wait for imaging if it delays surgery.

Step 4: Check the pyuria statement.
Option B says presence of pyuria, pus cells in urine, assists the diagnosis of torsion. This is false. Torsion is a purely vascular, mechanical problem, it does not cause pus cells in the urine. Pyuria instead points toward an infective cause of scrotal pain, such as epididymo-orchitis or a urinary tract infection, and is actually one of the ways doctors try to tell torsion apart from infection. So pyuria argues against torsion, it does not assist its diagnosis.

Step 5: Check the remaining two statements.
Option C, fixing the opposite testis, is true and important, since the anatomical defect, a bell clapper deformity, that allowed one testis to twist is usually present on both sides, so the other testis is fixed at the same operation to prevent it twisting later. Option D, that raising the testis worsens the pain, is also a recognised clinical sign, this is the basis of a negative Prehn's sign, where lifting the scrotum does not relieve pain in torsion, unlike in epididymitis, where lifting the testis, a positive Prehn's sign, tends to relieve pain.

Step 6: Final answer.
Since A, C, and D are all true and only B is false, the answer is
\[ \boxed{\text{Presence of pyuria assists the diagnosis}} \]