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
- gray-scale ultrasound
- power Doppler ultrasound
- color Doppler ultrasound
Tests to consider
- spectral Doppler
- 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.
Differentials
- Testicular appendix torsion
- Epididymitis or epididymo-orchitis
- Hydrocele
More DifferentialsGuidelines
- Paediatric urology
- A BURST-BAUS consensus document for best practice in the conduct of scrotal exploration for suspected testicular torsion
More GuidelinesPatient information
Appendicitis
Testicular cancer
More Patient information
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