History and physical examination findings predictive of testicular torsion: An attempt to promote clinical diagnosis by house staff

Based on physical examination alone it is often difficult to accurately make a clinical diagnosis and decide whether a palpable scrotal pathology arises from the testis itself or from extratesticular elements within the scrotum. Clinical examination of the testis is especially difficult due to pain, tenderness or when obscured by a large hydrocele. The aim of the study was thus undertaken to evaluate the role of ultrasonography (USG) in patients presenting with scrotal pain. 50 patients who presented to the surgical department with scrotal pain were subjected to USG. The commonest cause for scrotal pain was epididymitis with or without orchitis (40 %), followed in descending order by cystic lesions of the epididymis (18 %), varicocele (12 %), trauma (8 %), torsion (4 %) and tumour (2 %). No abnormality was seen on USG in 7 patients ( 14 %). This study concludes that USG is a sensitive and specific examination in patients with scrotal pain. Besides differentiating testicular from extratesticular origin it can also differentiate solid from cystic masses. Colour flow imaging is especially helpful in varicocele and testicular torsion. Torsion of the testis remains the most urgent and important entity dependent on USG for diagnosis. Journal of College of Medical Sciences-Nepal,2012,Vol-8,No-1, 18-22 DOI: http://dx.doi.org/10.3126/jcmsn.v8i1.6821

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Atypical presentation of testicular torsion: a case series

African Journal of Urology ◽

10.1186/s12301-021-00209-y ◽

2021 ◽

Vol 27 (1) ◽

Author(s):

Uzodimma Ejike Onwuasoanya

Keyword(s):

Physical Examination ◽

Testicular Torsion ◽

Age Groups ◽

Case Series ◽

Atypical Presentation ◽

Testicular Pain ◽

Future Fertility ◽

Urological Emergency ◽

High Index Of Suspicion ◽

Symptoms And Signs

Abstract Background Testicular torsion is a urological emergency and needs urgent intervention to prevent testicular loss and impaired future fertility. It is commonly seen in the neonatal and adolescent age groups. Testicular torsion can also present outside these common age groups with uncommon symptoms and signs. We report case series of patients managed at Lily Hospitals Limited, Warri, Delta State, Nigeria with atypical presentation of testicular torsion. Case Presentation The first patient was a 35-year-old male that presented with recurrent right testicular pain of 1-year duration, described as dull aching with no constitutional symptoms, physical examination findings were not pathognomonic of testicular torsion, he had scrotal exploration with right orchidectomy and left orchidopexy. The second patient was a 39-year-old male who presented with recurrent right testicular pain of 4-days duration, described as dull aching with no constitutional symptoms. Physical examination findings were not classical for testicular torsion, he had scrotal exploration with bilateral orchidopexy. Conclusion Testicular torsion although common in neonatal and adolescent age groups can also present outside these age groups with uncommon symptoms and signs, a high index of suspicion is thus invaluable in any patient presenting with testicular pain despite the age and severity to avoid missing the diagnosis as this can lead to testicular loss.

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TESTICULAR TORSION OF UNDESCENDED TESTIS IN A CHILD

The Professional Medical Journal ◽

10.29309/tpmj/2011.18.03.2389 ◽

2011 ◽

Vol 18 (03) ◽

pp. 535-537

Author(s):

MAQSOOD AHMAD ◽

MUMTAZ AHMAD ◽

MUHAMMAD SAQIB

Keyword(s):

Differential Diagnosis ◽

Early Diagnosis ◽

Physical Examination ◽

Blood Supply ◽

Spermatic Cord ◽

Testicular Torsion ◽

Undescended Testis ◽

Accurate Diagnosis ◽

Acute Scrotum ◽

Prompt Treatment

The children presenting with acute scrotum have many diseases in differential diagnosis and testicular torsion in undescended testis and normal testis is an important consideration. Torsion of the testis, or more correctly, torsion of the spermatic cord, is a surgical emergency because it causes strangulation of gonadal blood supply with subsequent testicular necrosis and atrophy. In most of cases history and physical examination are sufficient to make an accurate diagnosis. While other causes may require simple treatment but torsion require immediate exploration to save the testis. Early diagnosis and prompt treatment is essential to help such children.

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Management of testicular torsion <360° in children: a single-center, retrospective study

Journal of International Medical Research ◽

10.1177/0300060519895861 ◽

2019 ◽

Vol 48 (4) ◽

pp. 030006051989586

Author(s):

Xiang Guo ◽

Lan Sun ◽

Wei Lei ◽

Shuang Li ◽

Hui Guo

Keyword(s):

Blood Flow ◽

Retrospective Study ◽

Survival Rate ◽

Physical Examination ◽

Testicular Torsion ◽

Age Of Onset ◽

Clinical Manifestations ◽

Single Center ◽

Laboratory Examination ◽

Duration Of Symptoms

Objective This study aimed to summarize clinical manifestations, and physical examination, laboratory examination, and ultrasound results of children with testicular torsion <360°. Methods We performed a retrospective study of children who were diagnosed with testicular torsion <360° between October 2007 and October 2017. Results There were 11 (19.2%) patients with testicular torsion of 90°, 33 (58.0%) with 180°, and 13 (22.8%) with 270°. The median age of onset was 5.7 years (range, 1–14 years) and the median duration of symptoms was 4.2 days (range, 0.5–5 days). Ultrasound showed low blood flow in 46 (80.8%) patients. The testis was retained in 41 (72.0%) patients and resected in 16 (28.0%). The testes appeared necrotic at 2 to 3 days after onset for patients with 270° torsion, appeared necrotic at 3 to 4 days after onset for those with 180° torsion, and were not necrotic at 4 to 5 days after onset for those with 90° torsion. The duration of symptoms in children decreased as the torsion angle increased. Conclusion Children with testicular torsion <360° are relatively young, while the duration of symptoms is relatively long. A high postoperative testicular survival rate is one of the clinical features in this study.

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Ultrasound in urology: Part two: Diagnostics of male genitalis

Serbian Journal of Anesthesia and Intensive Therapy ◽

10.5937/sjait2004089z ◽

2020 ◽

Vol 42 (5-6) ◽

pp. 119-124

Author(s):

Bojan Čegar ◽

Uroš Bumbaširević ◽

Milica Stojadinović ◽

Nebojša Bojanić ◽

Danijela Sekulić ◽

...

Keyword(s):

Decision Making ◽

Physical Examination ◽

Clinical Diagnosis ◽

High Frequency ◽

Male Genitalia ◽

The Other ◽

Clear Picture ◽

Basic Method ◽

High Frequency Ultrasound ◽

Frequency Ultrasound

Male genitalia includes the penis, testicles and the prostate. Ultrasound is a basic method for prostate exam, due to its obscure position deep in the pelvis. On the other hand, penis and scrotal content are very available to physical examination, but thanks to proximity to surface of the skin, the high frequency ultrasound gives us clear picture of the interior of this organs and that is why we use this method for the confirmation of clinical diagnosis and in decision making for further treatment.

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Testicular Torsion

Pediatrics in Review ◽

10.1542/pir.15.11.455 ◽

1994 ◽

Vol 15 (11) ◽

pp. 455-456

Keyword(s):

Physical Examination ◽

Testicular Torsion ◽

Neonatal Period ◽

Acute Onset ◽

Nausea And Vomiting ◽

Surgical Exploration ◽

Urethral Discharge ◽

Testicular Pain ◽

Prompt Diagnosis ◽

Careful History

Testicular torsion is a surgical emergency having an incidence that is probably underestimated at 1 in 4000 males. While torsion may occur at any age, its peak incidence is in adolescence (12 to 18 years) and the neonatal period. A prompt diagnosis is necessary to optimize the chance for testicular salvage by surgical exploration via detorsion and bilateral orchidopexy. A careful history and physical examination should lead to the diagnosis of testicular torsion. Adolescents often present having the acute onset of lateralized scrotal or testicular pain that is intense, unaffected by position, and associated with nausea and vomiting. There are no associated voiding complaints, urethral discharge, or fever.

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