title: Testicular torsion: diagnosis, evaluation, and management.
abstract: Testicular torsion is a twisting of the spermatic cord and its contents and is a surgical emergency affecting 3.8 per 100,000 males younger than 18 years annually. It accounts for 10% to 15% of acute scrotal disease in children, and results in an orchiectomy rate of 42% in boys undergoing surgery for testicular torsion. Prompt recognition and treatment are necessary for testicular salvage, and torsion must be excluded in all patients who present with acute scrotum. Testicular torsion is a clinical diagnosis, and patients typically present with severe acute unilateral scrotal pain, nausea, and vomiting. Physical examination may reveal a high-riding testicle with an absent cremasteric reflex. If history and physical examination suggest torsion, immediate surgical exploration is indicated and should not be postponed to perform imaging studies. There is typically a four- to eight-hour window before permanent ischemic damage occurs. Delay in treatment may be associated with decreased fertility, or may necessitate orchiectomy.
authors.affiliation: University of Iowa Carver College of Medicine, Iowa City, IA, USA.
authors.forename: Victoria J
authors.initials: VJ
authors.lastname: Sharp
authors.affiliation: University of Iowa Carver College of Medicine, Iowa City, IA, USA.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Kieran
authors.affiliation: Children's Healthcare of Atlanta and Emory University, Atlanta, GA, USA.
authors.forename: Angela M
authors.initials: AM
authors.lastname: Arlen
mesh_terms: D017677:Age Distribution; D003937:Diagnosis, Differential; D004630:Emergencies; D006801:Humans; D008297:Male; D009919:Orchiectomy; D010808:Physical Examination; D013086:Spermatic Cord Torsion / Q000175:diagnosis / Q000601:surgery; D018608:Ultrasonography, Doppler