© 2 0 0 3 B J U I N T E R N A T I O N A L | 9 1 , 1 | doi:10.1046/j.1464-410X.2003.04194.x 1 Case report SYNCHRONOUS BILATERAL TESTICULAR TORSION F.H. ANJUM et al. Masturbation inducing synchronous bilateral testicular torsion in an adolescent F.H. ANJUM, G.M. OADES, S. RAO* and T. TASSADAQ Departments of Urology and *Radiology, Broomfield Hospital, Chelmsford, Essex, UK recent exercise and bicycle riding have been implicated. Masturbation is a largely unrecognized risk factor for testicular torsion [3] and this is the only reported case of bilateral synchronous testicular torsion after this activity. It is possible that cremasteric reflex contraction during ejaculation could result in testicular torsion in a situation where an anatomical predisposition to testicular torsion exists. In addition to their ascent, the testicles undergo a change in axis of suspension during the process of cremasteric contraction, and rotate medially. This case emphasizes the need to include torsion in the differential diagnosis of bilateral testicular pain, and a history of masturbation should be sought in cases of acute testicular pain. The scrotum should be explored if there is any doubt of the diagnosis, with fixation of both testes. The practice of external fixation of the CASE REPORT A 13-year-old boy was admitted with a 36-h history of bilateral testicular pain, worse on the right, which started after he had masturbated. He had undergone left herniotomy when aged 6 months. The patient was apyrexial; on examination the right hemiscrotum was inflamed with an enlarged, high-riding right testicle. The left hemiscrotum appeared normal. Immediate surgical exploration by bilateral scrotal incision revealed bilateral intravaginal testicular torsion, 360∞ clockwise on the right and 720∞ anticlockwise on the left. At 15 min after untwisting, the testicular colour improved and it was fixed using three-point fixation. Scrotal ultrasonography at the 6- month follow-up showed normal testes (Fig. 1) and the hormonal profile (FSH, LH and testosterone) remains normal. COMMENT 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 ª 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 contralateral testis without visualization should be condemned. REFERENCES 1 Southgate MT, Bessen HA, Haynes VE. The diagnosis of testicular torsion. JAMA 1983; 249: 2522–7 2 Washowich TL. Synchronous bilateral testicular torsion in an adult. J Ultrasound Med 2001; 20: 933–5 3 Denis L. Diagnosis of testicular torsion. Acta Urologica Belgica 1968; 36: 425–8 Correspondence: Mr F.H. Anjum, Department of Urology, Broomfield Hospital, Chelmsford, Essex CM1 7ET, UK. e-mail: anjumfaqar@aol.com FIG. 1. Normal Doppler ultrasonography of both testes at 6 months.