Testicular torsion
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 investigations
1st investigations to order
- gray-scale ultrasound
- power Doppler ultrasound
- color Doppler ultrasound
Investigations to consider
- spectral Doppler
- urinalysis
- scintigraphy
Treatment algorithm
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.
Differentials
- Testicular appendix torsion
- Epididymitis or epididymo-orchitis
- Hydrocele
More DifferentialsGuidelines
- Guidelines on paediatric urology
- ACR appropriateness criteria: acute onset of scrotal pain - without trauma, without antecedent mass
More GuidelinesPatient leaflets
Appendicitis
Testicular cancer
More Patient leaflets
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