Testicular torsion is a urologic emergency, accounting for up to 15% of cases of acute scrotal pain. Rapid recognition and management are essential to ensure viability of the testis. Doppler ultrasound can be used to confirm the diagnosis of testicular torsion; however, recent studies suggest that a more judicious use of ultrasound may be safe, decrease delays in surgical management, and avoid unnecessary utilization of resources.
Our recent issue Emergency Department Management of Acute Scrotal Pain in Pediatric Patients reviews the epidemiology and historical and physical examination findings of testicular torsion and other common causes of acute scrotal pain. The existing literature is reviewed and recommendations are provided to guide the emergency clinician in appropriate management and disposition of boys with acute scrotal pain.
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Here are a few key points:
- Epididymitis is a common cause of acute testicle pain and is usually due to a viral or postviral process. Bacterial causes and antibiotics should be considered in sexually active males, patients with recurrent epididymitis, and/or those with urinary tract symptoms. A urine culture can be considered for patients with this condition, though most will be negative.
- The most common cause of acute testicle pain in prepubertal patients is testicular appendage torsion. Management is supportive, with rest, nonsteroidal anti-inflammatory drugs, and scrotal support (briefs rather than boxers, and a rolled towel under the scrotum when sitting or recumbent).
- Healthcare systems should prioritize rapid assessment of patients with testicle pain to screen for testicular torsion. Workflows should be developed to expedite timely recognition, diagnosis, treatment, and transfer for patients with testicle pain.
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