Testicular torsion is an emergency condition due to rotation of the testis and consequent strangulation of its blood supply. Diagnosis is based on physical examination and confirmed by color Doppler ultrasonography. Treatment is immediate manual detorsion followed by surgical intervention. Testicular torsion must be strongly considered in all adolescents who present with acute scrotal pain, particularly if accompanied by nausea. Physical exam findings are highly variable and include tenderness, scrotal swelling and/or erythema, and loss of cremasteric reflex. The unaffected testis may be elevated or have a transverse lie. The Prehn sign (relief of pain by elevation of the affected testis) is now known to not accurately distinguish epididymitis from testicular torsion and should not be relied upon. The diagnosis is typically clinical in nature, and surgical exploration should not be delayed. In equivocal cases, a scrotal ultrasound with Doppler flow assessment should be obtained. Early surgical exploration by urology with bilateral orchidopexy is necessary to provide the best change for testicular survival. Salvage rates in testicular torsion drop dramatically from 80 to 100% at 6 to 8 h to near zero at 12 h after symptom onset.
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References:
Ta A, D'Arcy FT, Hoag N, D'Arcy JP, Lawrentschuk N. Testicular torsion and the acute scrotum: Current emergency management. Eur J Emerg Med 2015 doi: 10.1097/MEJ.0000000000000303 [doi].
Wang J. Testicular torsion. Urological Science 2012;23(3):85-86. doi: https://dx.doi.org/10.1016/j.urols.2012.07.009.
Crawford P, Crop JA. Evaluation of scrotal masses. Am Fam Physician 2014;89(9):723-727. doi: d10863 [pii].
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