25 year old man is admitted to a district hospital with sudden onset of Right testicular pain of few hours duration .There was no assosciated trauma or recent unprotected sex. His condition wasn’t preceeded by urinary symptoms or fever.Patient was put on antibiotics   and  analgesics and discharged after two days. This happened to be the second time patient was experiencing such a problem.
Three years earlier patient had a similar episode in the Left scrotum for which similar line management like the current presentation was adopted.  Patient noticed that the left testes had disappeared 3months afterward.
Fearing he might lose this one too , his brother who happens to know a urologist at KATH , Kumasi brought him for further ,  managment
Examination  : Empty left hemiscrotum with a hard right testis drawn up with a horizontal lie. Cremasteric reflex , absent
Diagnosis:  Rt testicular torsion
Surgery : Right hemiscrotal exploration done. Testes not viable after application of warm packs for 10 minutes. Patient and relatives consent sought further and total orchidectomy done. Testis sent for histology
Findings : Gangrenous  Right testis
Post surgery: Patient recovered well. Two weeks afterwards his serum tesosterone had reached castrate levels. The consequences have fully been explained to the patient and he is a very worried young man.
Credits : Dr Arhin, Urologist, KATH , Kumasi.