Testicular torsion

Last reviewed: 28 Apr 2022
Last updated: 07 Dec 2021

Summary

Definition

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
More key diagnostic factors

Other diagnostic factors

  • nausea and vomiting
  • abdominal pain
  • fever
Other diagnostic factors

Risk factors

  • age under 25 years
  • neonate
  • bell clapper deformity
  • trauma/exercise
  • intermittent testicular pain
  • undescended testicle
  • cold weather
More risk factors

Diagnostic investigations

1st investigations to order

  • grey-scale ultrasound
  • power Doppler ultrasound
  • colour Doppler ultrasound
More 1st investigations to order

Investigations to consider

  • spectral Doppler
  • urinalysis
  • scintigraphy
More investigations to consider

Treatment algorithm

ACUTE

non-neonate

neonate

Contributors

Authors

Hemanshoo Thakkar, MD

Consultant Paediatric Surgeon

Evelina London Children’s Hospital

Guy's and St Thomas' NHS Foundation Trust

London

UK

Disclosures

HK declares that he has no conflicting interests.

Richard Lee, MD

Associate Professor of Urology

Department of Urology

Weill Cornell Medical College

New York City

NY

Disclosures

RL has received funding from the Bill and Melinda Gates Foundation.

Caroline Kang, MD, PhD

Fellow in Male Reproductive Medicine and Surgery

Department of Urology

Weill Cornell Medical College

New York City

NY

Disclosures

CK declares that she has no conflicting interests.

Jessica Marinaro, MD

Fellow in Male Reproductive Medicine and Surgery

Department of Urology

Weill Cornell Medical College

New York City

NY

Disclosures

JM declares that she has no conflicting interests.

Acknowledgements

Dr Hemanshoo Thakkar, Dr Richard Lee, Dr Caroline Kang, and Dr Jessica Marinaro would like to gratefully acknowledge Dr George Kaplan, Dr Deborah Dean and Dr Paul Hamilton, the previous contributors to this topic.

Disclosures

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.

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