questions 3

Testicular Torsion

Topic updated on 08/01/17 5:39pm


  • A neonatal boy is brought to his pediatrician for concern of a blue mass in the scrotum. His parents noticed this an hour ago. On physical exam, the scrotum is blue and firm with some erythema. Transillumination test is negative. Doppler ultrasound shows absent blood flow. The neonate is immediately sent to hospital for surgery.
  • Clinical definition
    • twisting of spermatic cord that results in compromised blood flow and ischemia
      • this is considered a surgical emergency
  • Epidemiology
    • demographics
      • neonatal
      • adolescent years
    • risk factors
      • prior history of testicular torsion
      • recent trauma to the testes
  • Pathogenesis
    • processus vaginalis (path as testes leaves abdomen with peritoneal lining) twists, causing decreased or absent blood flow to the testis and epididymis
  • Prognosis
    • prognostic variable
      • favorable
        • rapid time to surgery
  • Symptoms
    • primary symptoms
      • in adolescents
        • acute onset and severe pain in unilateral scrotum
        • nausea
        • vomiting
      • in neonates
        • blue and firm unilateral scrotal mass
  • Physical exam
    • inspection
      • high riding testis
      • erythema and swelling
    • tenderness to palpation
    • absent cremasteric reflex 
  • Doppler ultrasound
    • indications
      • if testicular torsion is suspected but not confirmed with physical exam and history
    • findings
      • decreased or absent blood flow
  • Urinalysis
    • to rule out epididymitis
  • Diagnostic criteria
    • diagnosed by history and physical exam
    • diagnosis confirmed only during surgery
  • Epididymitis
    • positive cremasteric reflex
  • Operative
    • orchiopexy (bilateral)
      • indications
        • within 24 hours of disease onset
          • 4-8 hour window before there is permanent damage from ischemia
      • bilateral orchiopexy should be performed as contralateral testis is also at risk for future torsion
      • outcomes
        • 90-100% with viable testes if within 6 hours
        • 50% if within 12 hours
        • <10 % if after 24 hours
    • orchiectomy
      • indications
        • if testis is not viable
  • Non-operative
    • manual detorsion
      • indications
        • if surgery is not available or delayed
  • Testicular ischemia
  • Infertility or subfertility



Qbank (3 Questions)

(M3.RL.25) A 15-year-old boy presents to the emergency room with severe lower abdominal pain that awoke him from sleep about 3 hours ago. The pain is sharp and radiates to the left thigh. While in the emergency room, the patient experiences one episode of vomiting. He denies any fever, dysuria or chills. Physical examination reveals normal vitals with blood pressure 100/60 and temperature of 98.6F. Abdominal examination is relatively benign. Scrotal examination reveals an elevated left testis that is diffusely tender. The cremasteric reflex is absent. What is the next step in the management of this patient? Topic Review Topic

1. CT scan of abdomen and pelvis
2. Testicular doppler ultrasound
3. Surgical exploration
4. IV antibiotics
5. KUB x-ray

(M2.RL.4) A 16-year-old male presents to the emergency room with a 6-hour history of scrotal pain of sudden onset. The patient’s past medical history is insignificant, though upon questioning he reports sleeping with several women in the prior three month period. On physical examination the testes appear to have a horizontal lie and the scrotum is neither swollen nor discolored. Doppler ultrasonography shows decreased blood flow to the affected testicle. Which of the following is the most likely diagnosis: Topic Review Topic

1. Testicular torsion
2. Epididymitis
3. Seminoma
4. Orchitis
5. Traumatic urethral injury

(M2.RL.54) A 25-year-old male comes into the emergency department complaining excruciating testicular pain. The patient states that he was at the park playing basketball with his friends when the pain "hit me like a freight train". He denies any trauma to the groin, fevers, or chills but has been nauseous and had a few episodes of vomiting since the pain started. On physical examination he is noted to have an edematous scrotum with the testes found high in the scrotum. What is the most appropriate course of action to take with this individual? Topic Review Topic

1. Pelvic radiograph
2. Ultrasonography
3. Magnetic resonance imaging
4. Computed tomography scan
5. Emergent surgical exploration


Evidence & References Show References

Topic Comments

Subscribe status: