Summary
Definition
History and exam
Key diagnostic factors
- testicular pain
- intermittent pain
- no pain relief upon elevation of scrotum
- scrotal swelling or edema
- scrotal erythema
- reactive hydrocele
- high-riding testicle
- horizontal lie
- absent cremasteric reflex
Other diagnostic factors
- nausea and vomiting
- abdominal pain
- fever
Risk factors
- age <25 years
- neonate
- bell clapper deformity
- trauma/exercise
- intermittent testicular pain
- undescended testicle
- cold weather
Diagnostic tests
1st tests to order
- Testicular Workup for Ischemia and Suspected Torsion (TWIST) score
- ultrasound with Doppler flow imaging
Tests to consider
- urinalysis
- scintigraphy
Treatment algorithm
non-neonate
neonate
Contributors
Authors
Hemanshoo Thakkar, MBBS, BSc, FRCS (Paed)
Consultant Paediatric Surgeon
Evelina London Children’s Hospital
Guy's and St Thomas' NHS Foundation Trust
London
UK
Disclosures
HT declares that he has no conflicting interests.
Acknowledgements
Dr Hemanshoo Thakkar would like to gratefully acknowledge Dr Richard Lee, Dr Caroline Kang, and Dr Jessica Marinaro, Dr George Kaplan, Dr Deborah Dean, and Dr Paul Hamilton, the previous contributors to this topic.
Disclosures
RL has received funding from the Bill and Melinda Gates Foundation. CK, JM, GK, DD, and PH declared that they had no competing interests.
Peer reviewers
Eugene Minevich, MD, FAAP, FACS
Associate Professor
Division of Pediatric Urology
Cincinnati Children's Hospital Medical Center
Cincinnati
OH
Disclosures
EM declares that he has no competing interests.
Simon E. Kenny, BSc, ChB (Hons), MD, FRCS (Paed), FAAP
Consultant Pediatric Surgeon/Urologist
Alder Hey Children's NHS Foundation Trust
Liverpool
UK
Disclosures
SEK declares that he has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
National Confidential Enquiry into Patient Outcome and Death. Testicular torsion. Feb 2024 [internet publication].Full text
Royal College of Surgeons of England. Commissioning guide topics: management of paediatric torsion. Oct 2016 [internet publication].Full text
European Association of Urology. Paediatric urology. Apr 2024 [internet publication].Full text
Expert Panel on Urological Imaging, Gerena M, Allen BC, et al. ACR appropriateness criteria® acute onset of scrotal pain-without trauma, without antecedent mass: 2024 update. J Am Coll Radiol. 2024 Nov;21(11s):S364-71.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Testicular appendix torsion
- Epididymitis or epididymo-orchitis
- Hydrocele
More DifferentialsGuidelines
- Appropriateness criteria: acute onset of scrotal pain - without trauma, without antecedent mass
- Paediatric urology
More GuidelinesPatient information
Appendicitis
Testicular cancer
More Patient information
Log in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer