Testicular torsion is a urologic emergency caused by the twisting of the testicle on the spermatic cord leading to constriction of the vascular supply and time-sensitive ischemia and/or necrosis of testicular tissue.
High index of suspicion is important to ensure timely diagnosis and management.
A history and physical exam consistent with testicular torsion mandates an immediate surgical consult for scrotal exploration.
If history and physical exam 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 urologic emergency caused by the twisting of the testicle on the spermatic cord leading to constriction of the vascular supply, time-sensitive ischemia, 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 edema
- scrotal erythema
- reactive hydrocele
- high-riding testicle
- horizontal lie
- absent cremasteric reflex
Other diagnostic factors
- nausea and vomiting
- abdominal pain
- age <25 years
- bell clapper deformity
- intermittent testicular pain
- undescended testicle
- cold weather
1st investigations to order
- gray-scale ultrasound
- power Doppler ultrasound
- color Doppler ultrasound
Investigations to consider
- spectral Doppler
- Testicular appendix torsion
- Epididymitis or epididymo-orchitis
- Guidelines on paediatric urology
- ACR appropriateness criteria: acute onset of scrotal pain - without trauma, without antecedent mass
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