Testicular Torsion as a Cause of Acute Scrotum

Is it possible to distinguish testicular torsion and other causes of acute scrotum in patients who underwent scrotal exploration? A multi-center, clinical trial


Objectives: We assessed the importance of the clinical presentation of boys who underwent surgical exploration for acute scrotum.

Materials and Methods: We retrospectively analyzed the records of 97 boys (≤25 years old) who underwent surgical exploration for acute scrotum between May 2007 and July 2013. Diagnosis of acute scrotum was confirmed by physical examination, colour Doppler ultrasound (CDUS) and laboratory findings.

Results: In total, 97 scrotal explorations were carried out for acute scrotal pain. 74.2% (n=72) had testicular torsion (TT), 25.8% (n=25) had other pathologies included torsion of testicular appendage (n=13), epididymo-orchitis (n=8), testicular trauma (n=2), and Henoch-Schönlein purpura (n=2). In the TT group, 32 cases (44.4%) presented to hospital within the less than 6 hours after pain onset, and more than half (64%) others group cases presented >24 hours after pain onset. Fever and pyuria appeared more frequently in the others group than in the TT group, and the results reached statistical significance. Patients with TT had more testicular tenderness compared to the others group (p<0.001). Our testicular salvage rate was 59.7% and missed testicular torsion rate was 40.3%.

Conclusions: CDUS was largely predicted the diagnosis of TT (sensitivity, 98.6%). Clinical findings such as testicular tenderness, fever and pyuria may be helpful in making the differentiation in TT and others (nonsurgical) group.

Key words: surgical acute scrotum; non-surgical acute scrotum; testicular torsion; torsion of testicular appendages; epididymo-orchitis; scrotal exploration.


When acute scrotal pain is experienced by a child or teenage boy in his adolescence, one should always treat this condition as an emergent condition, whether or not it is accompanied by swelling. Torsion of the spermatic cord, epididymo-orchitis, torsion of testicular appendages, trauma, tumor, hernia, idiopathic scrotal edema vasculitis and cellulitis are signs looked for when diagnosing acute scrotum. Although the majority of these conditions are non-emergent, when torsion of the spermatic cord occurs, it is vital that it be immediately diagnosed and treated. If it is not, the testicle could suffer permanent ischemic damage (1). The most common causes of acute scrotum in young people are testicular torsion (TT), epididymo-orchitis (EO), torsion of testicular appendage (TTA), and epididymo-orchitis (EO) (2-4). Because of the possible risk of permanent damage to the testicle, it is vitally important to determine whether the acute scrotal pain is caused by testicular torsion or something else. In the past, medical professionals have used sonography and clinical findings to help determine the cause (5,6).

This study examines the results of scrotal exploration, the symptoms and signs of acute scrotum and ways to distinguish whether testicular torsion or other factors are the cause of acute scrotum in young patients.


97 patients underwent exploration of scrotum for acute scrotal pain between May 2007 and July 2013. A retrospective review off all boys up to the age of 25 years. Data were obtained retrospectively maintained hospital databases of all patients who underwent scrotal exploration in four tertiary referral centres (Suleyman Demirel University Faculty of Medicine, Isparta, Haydarpasa Training and Research Hospital, Istanbul, Tepecik Training and Research Hospital, Izmir, and Fatih Sultan Mehmet Training and Research Hospital, Istanbul).

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