From the Guidelines
Testicular torsion in 14-year-old adolescents typically presents as sudden, severe pain in one testicle, often accompanied by swelling, redness, and tenderness of the affected scrotum, and requires immediate medical attention to preserve testicular viability. The pain may radiate to the lower abdomen and can cause nausea and vomiting. The affected testicle may appear higher than normal due to shortening of the spermatic cord, and the cremasteric reflex (normal elevation of the testicle when the inner thigh is stroked) is usually absent 1.
Clinical Presentations
- Sudden, severe pain in one testicle
- Swelling, redness, and tenderness of the affected scrotum
- Pain radiating to the lower abdomen
- Nausea and vomiting
- Affected testicle may appear higher than normal
- Absent cremasteric reflex
According to the most recent study 1, testicular torsion is a surgical emergency with a bimodal distribution presenting more frequently in neonates and postpubertal boys than in adults, although it can occur at any age. Prompt recognition and surgical exploration within 6 to 8 hours after symptom onset is essential to prevent testicular loss 1.
Diagnostic Considerations
- Ultrasound (US) is the established first-line imaging modality for acute scrotal disease 1
- US findings in testicular torsion include an enlarged heterogeneous testis, ipsilateral hydrocele, skin thickening, and no color Doppler flow in the testis or spermatic cord 1
- A twisted spermatic cord is the most specific US sign of torsion 1
It's essential to note that delay in treatment can lead to testicular ischemia, necrosis, and potential loss of the affected testicle, which can impact fertility. Therefore, immediate medical attention is crucial in cases of suspected testicular torsion. Treatment involves surgical intervention called orchiopexy to untwist the testicle and secure it to prevent recurrence, and the contralateral testicle is also typically secured during the procedure 1.
From the Research
Clinical Presentations of Testicular Torsion
The clinical presentations of testicular torsion in 14-year-old adolescents include:
- Sudden onset of severe unilateral testicular pain
- Nausea and vomiting
- Swollen scrotum
- High-riding testicles with an absent cremasteric reflex and negative Prehn sign 2
- Decrease or absence of blood flow in the affected testicle, as revealed by color Doppler ultrasound 3, 4
Diagnostic Features
Diagnostic features of testicular torsion include:
- The whirlpool sign of the spermatic cord on ultrasonography, which is the most specific ultrasonographic feature 4
- A relative decrease or absence of blood flow in the affected testicle, as revealed by color Doppler ultrasound 3, 4
- Physical examination findings, such as a high-riding testicle with an absent cremasteric reflex 2
Importance of Prompt Diagnosis and Treatment
Prompt diagnosis and treatment of testicular torsion are crucial to prevent permanent ischemic damage and preserve testicular viability:
- There is typically a four- to eight-hour window before permanent ischemic damage occurs 2
- Delay in treatment may be associated with decreased fertility or may necessitate orchiectomy 2
- Manual detorsion should be performed as soon as possible before surgical intervention, and ultrasound guidance can improve the success rate of the procedure 3, 4