Testicular Disorders Testicular Torsion

Although occasionally seen in the newborn male, testicu-lar torsion is an acquired condition seen during puberty and is an emergency. It usually presents with abrupt onset of severe scrotal pain, at times waking the patient up in the early morning. Associated signs and symptoms include fever, nausea, vomiting, and abdominal pain. Intermittent testicu-lar torsion has been described. On physical examination, the testis may lie in a more horizontal position, caused by a lack of normal attachment to the tunica vaginalis ("bell clapper" deformity), and demonstrate a loss of the cremasteric reflex. The diagnosis of testicular torsion can be made by physical examination or with the assistance of color Doppler ultrasound; however, physical examination is unreliable for ruling torsion in or out (Schmitz and Safranek, 2009). Timeliness of the diagnosis is critical, because testicular viability declines to 0% if detorsion occurs 24 hours after the onset of symptoms (Brenner and Ojo, 2004). Testicular torsion can occur in systemic illnesses, such as Henoch-Schonlein purpura, or can mimic the symptoms of other conditions, such as appendicitis or nephrolithiasis.

Torsion of the appendix testis presents similar to testicular torsion, although the symptoms are not as severe. The classic patient is a boy age 7 to 12 years. Palpation of the testis is normal except for a small, tender, palpable mass located on the superior or inferior pole. The cremasteric reflex is intact. The "blue dot" sign may be present and represents the compromised appendix testis as viewed through the scrotum. Diagnosis is generally made clinically and treatment is supportive, including analgesia and scrotal elevation. It is not unusual for the pain to last 5 to 10 days, but chronic pain may occur and warrants urology consultation.

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