From the Guidelines
Partial testicular torsion typically presents with intermittent scrotal pain, nausea, vomiting, and scrotal swelling, and can be ruled out with a normal color Doppler ultrasound showing symmetric blood flow to both testes, although clinical suspicion should still guide management. The symptoms of partial torsion can be subtle and may include a tender testicle with an abnormal lie, and the cremasteric reflex might still be present 1. To diagnose partial torsion, spectral Doppler analysis of the arterial waveform can be used, looking for abnormalities such as diminished arterial velocity, decreased diastolic flow, and an increased resistive index, which can indicate severe obstruction or occlusion of the venous outflow 1. Some key characteristics of the spectral Doppler waveform in partial testicular torsion include:
- Variability of the amplitude
- Reversal of diastolic flow
- Monophasic waveform
- Tardus-parvus morphology
- Spectral Doppler waveform variations within the same testis These abnormalities can be indicative of underlying ischemia and should be evaluated in the upper, mid, and lower poles of each testicle 1. Manual detorsion with pain relief, normal testicular positioning on examination, absence of the "bell-clapper" deformity on imaging, and alternative confirmed diagnoses such as epididymitis or orchitis can help rule out torsion, but if clinical suspicion remains high, surgical exploration may still be necessary 1.
From the Research
Symptoms of Partial Torsion
- Severe acute unilateral scrotal pain 2
- Nausea and vomiting 2
- High-riding testicle with an absent cremasteric reflex 2
- Pain relief as the endpoint for detorsion, but up to one-third of patients may continue to show signs of residual torsion 3
Rules to Exclude Partial Torsion
- Color Doppler ultrasound to confirm complete manual detorsion and restoration of blood flow to the testis 4, 3, 5
- Normal color Doppler ultrasound results after manual detorsion 5
- Successful manual detorsion defined as complete pain resolution with a normal color Doppler ultrasound 5
- Surgical exploration to confirm the absence of cord torsion 5