Testicular torsion is a urological emergency caused by the twisting of the testicle on the spermatic cord leading to constriction of the vascular supply and time-sensitive ischaemia and/or necrosis of testicular tissue.
High index of suspicion is important to ensure timely diagnosis and management.
A history and physical examination consistent with testicular torsion mandates an immediate surgical consult for scrotal exploration.
If history and physical examination suggest testicular torsion, immediate surgical consultation and exploration should take precedence over diagnostic tests.
Usually affects young males but may affect males of any age.
Testicular torsion is a urological emergency caused by the twisting of the testicle on the spermatic cord leading to constriction of the vascular supply, time-sensitive ischaemia, and/or necrosis of testicular tissue.
History and exam
Key diagnostic factors
- testicular pain
- intermittent pain
- no pain relief upon elevation of scrotum
- scrotal swelling or oedema
- scrotal erythema
- reactive hydrocele
- high-riding testicle
- horizontal lie
- absent cremasteric reflex
Other diagnostic factors
- nausea and vomiting
- abdominal pain
- age under 25 years
- bell clapper deformity
- intermittent testicular pain
- undescended testicle
- cold weather
1st investigations to order
- grey-scale ultrasound
- power Doppler ultrasound
- colour Doppler ultrasound
Investigations to consider
- spectral Doppler
- Testicular appendix torsion
- Epididymitis or epididymo-orchitis
- Guidelines on paediatric urology
- Acute Scrotal Pain and Suspected Testicular Torsion.
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