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Understanding Testicular Torsion: Symptoms, Management, and Treatment Guidelines

Testicular torsion is a urological emergency characterized by sudden onset of severe unilateral scrotal pain, which may radiate to the inguinal area or lower abdomen. Symptoms often include nausea and vomiting. The "golden" window for surgical intervention is within 4 to 8 hours to preserve testicular viability. Prompt consultation with urology is essential. This guide covers immediate management strategies, including surgical detorsion and fixation (orchidopexy) or orchiectomy if the testis is nonviable, as well as diagnostic imaging and treatment for associated conditions like epididymitis.

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Understanding Testicular Torsion: Symptoms, Management, and Treatment Guidelines

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  1. December 17, 2010 Welcome Applicants! Scrotal Pain

  2. Testicular Anatomy

  3. Testicular Torsion

  4. Classic Presentation Sudden onset of severe unilateral pain may radiate to inguinal area or lower abdomen +/- Nausea and vomiting (90%) Consider as secondary event Has been reported post-orchiopexy

  5. “Golden” window • 4 to 8hrs • 12hrs 20% viable • 24hrs nonviable • Consult urology immediately!!

  6. Testicular Torsion: Management • Orchiopexy: surgical detorsion and fixation of both testes • Orchiectomy is performed if the testicle is nonviable

  7. Testicular Torsion: Management • Manual Detorsion: “Open Book” rotation • Medial to lateral • Give appropriate sedation and analgesia • Still need surgical exploration after manual detorsion

  8. Imaging • Not necessary if strong clinical suspicion • Doppler U/S (69-100% sensitive, 77-100% specific) • Nuclear Scan measuring testicular perfusion (100% sensitive, 97% specific)

  9. Torsion of Appendix Testis or Appendix Epididymis

  10. Epididymitis • Most commonly caused by infection • Sexually Active Males: CT is #1, followed by GC, E.Coli, and viruses • Less Common: Ureaplasma, Mycobacterium, CMV, Cryptococcus in HIV+ • Pre-adolescents • Infectious: Mycoplasma, Enteroviruses, Adenoviruses • Non-infectious: may be caused by “chemical inflammation” from reflux of sterile urine

  11. Epididymitis • Risk Factors • Structural abnormalities • Sexual activity • Age • Heavy physical exertion • Bicycle/Motorcycle riding

  12. Epididymitis • UA and UCx should be obtained • Restrospective study: only 15% of patients with Epididymitis had a positive UA • UCx is often negative

  13. Sexually Active Males • When GC/CT suspected: • Ceftriaxone 250mg IM x 1 + Doxycycline 100mg PO BID x 14 days • Quinolones no longer recommended • For Enteric Organisms: • Levofloxacin 500mg PO Qday x 10 days • Ofloxacin 300mg PO BID x 10 days

  14. Pre-Pubertal Boys Bacterial Causes (if they have associated UTI): Bactrim or Cephalexin Non-Bacterial Causes: Supportive Measures (NSAIDs, Bed Rest, Scrotal Support, possibly Abx)

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