From the Guidelines
Testicular torsion is a surgical emergency that presents with sudden, severe pain in one testicle, often accompanied by scrotal swelling, redness, and tenderness, and requires immediate medical attention to prevent testicular loss 1. The signs and symptoms of testicular torsion can be subtle, but typically include:
- Sudden, severe pain in one testicle
- Scrotal swelling, redness, and tenderness
- Nausea and vomiting due to intense pain
- Abdominal pain that radiates to the groin
- The affected testicle may appear higher than normal or positioned abnormally in the scrotum
- The cremasteric reflex is typically absent on the affected side
- Symptoms may develop after physical activity, trauma, or during sleep It is essential to note that testicular torsion can occur at any age, but males between ages 12-18 are at highest risk 1. The use of ultrasound (US) is the established first-line imaging modality for acute scrotal disease and can help diagnose testicular torsion by evaluating testicular perfusion with color Doppler, power Doppler, and spectral Doppler US 1. Urgent medical attention is crucial, as testicular torsion requires treatment within 4-6 hours to save the testicle, and anyone experiencing sudden testicular pain should seek immediate emergency care rather than waiting to see if symptoms improve 1. The condition occurs when the spermatic cord twists, cutting off blood supply to the testicle, which can lead to tissue death if not promptly corrected 1. In some cases, US findings may include an enlarged heterogeneous testis, ipsilateral hydrocele, skin thickening, and no color Doppler flow in the testis or spermatic cord, and a twisted spermatic cord is the most specific US sign of torsion 1. It is crucial to integrate clinical data, including the presence of fever, waxing and waning pain, and laboratory markers for infection, to distinguish testicular torsion from other conditions such as epididymoorchitis 1.
From the Research
Signs and Symptoms of Testicular Torsion
- Sudden onset of severe unilateral testicular pain 2, 3, 4, 5
- Nausea and vomiting 2, 3, 4, 5
- Swollen scrotum 2, 5
- High-riding testicles 2, 5
- Absent cremasteric reflex 2
- Negative Prehn sign 2
- Abnormal testicular axis 6
- Abnormal echogenicity 6
- Enlargement of the affected testis and epididymis due to ischemia 6
Ultrasonographic Findings
- Spermatic cord twisting or the whirlpool sign 2, 6
- Absence of or decreased blood flow within the affected testis 2, 6
- Color Doppler ultrasound may reveal a relative decrease or absence of blood flow in the affected testicle 2