Symptoms of Testicular Torsion
Testicular torsion presents with sudden onset of severe, unilateral scrotal pain, often accompanied by nausea and vomiting, with a red, swollen scrotum and an acutely painful testicle that typically occurs without preceding trauma. 1, 2
Primary Clinical Features
The hallmark symptoms include:
- Abrupt onset of severe scrotal pain - This is the most characteristic feature that distinguishes torsion from other causes of testicular pain like epididymitis, which has a more gradual onset 1, 3
- Unilateral testicular pain - The pain is typically one-sided and acute 4
- Nausea and vomiting - These systemic symptoms are common accompaniments and help distinguish torsion from less serious conditions 1, 2, 4
Physical Examination Findings
Key physical signs that support the diagnosis:
- Red, swollen scrotum with a firm, tender testicle 2
- Negative Prehn sign - Pain is NOT relieved when the testicle is elevated, which is a critical distinguishing feature from epididymitis 1, 3
- Absent cremasteric reflex on the affected side - This is the most accurate clinical sign of testicular torsion, though its presence or absence alone is not completely reliable 5, 4
- Enlarged heterogeneous testis that may appear abnormal on examination 1
Age-Related Presentation Patterns
- Bimodal distribution - Torsion occurs most commonly in two age groups: neonates (first year of life) and postpubertal boys (ages 12-18 years), though it can occur at any age 1, 3, 4
- The condition is rare in patients over 35 years of age 1
Critical Clinical Pitfalls
- Trauma history can be misleading - Patients may report minor trauma, but progressive worsening pain with systemic symptoms points to torsion rather than simple injury 3
- Normal urinalysis does NOT exclude testicular torsion - This is a common pitfall, as clinicians may be falsely reassured by normal urine studies 1
- Significant overlap exists in clinical presentation between torsion, epididymitis, and torsion of testicular appendage, making diagnosis challenging based on symptoms alone 1, 3
Time-Critical Nature
- The 6-8 hour window is critical - Testicular viability may be compromised if treatment is not initiated within 6-8 hours of symptom onset, with surgical outcomes significantly better when surgery occurs within 12 hours 1, 6, 5
- Testicular salvage rates decline significantly after this critical window, making immediate recognition of symptoms essential 6, 5