A 16-year-old male presents with sudden severe scrotal pain and swelling; Doppler ultrasound shows decreased blood flow. What is the most appropriate next step?

• A. scrotal elevation and ice packs
• B. emergent surgery
• C. oral doxycycline
• D. incision and drainage

Answer: (B)

Testicular torsion is a surgical emergency: sudden, severe scrotal pain with decreased testicular blood flow on Doppler means the testis is twisted and losing arterial supply. Salvaging the testicle hinges on rapid detorsion and fixation, because the window for viability is very time-sensitive. The most appropriate next step is emergent surgical exploration to detorse the spermatic cord and perform bilateral orchiopexy to prevent recurrence; if the testis is found nonviable, removal is performed. While a manual detorsion can be considered as a temporary measure if surgery is unavailable immediately, it does not replace definitive surgical management. Delaying definitive treatment or pursuing nonoperative approaches would risk losing the testicle.