Overview Snapshot A neonatal boy is brought to his pediatrician for concern of a blue mass in the scrotum. His parents noticed this an hour ago. On physical exam, the scrotum is blue and firm with some erythema. Transillumination test is negative. Doppler ultrasound shows absent blood flow. The neonate is immediately sent to hospital for surgery. Introduction Clinical definition twisting of spermatic cord that results in compromised blood flow and ischemia this is considered a surgical emergency Epidemiology demographics neonatal adolescent years risk factors prior history of testicular torsion recent trauma to the testes Pathogenesis processus vaginalis (path as testes leaves abdomen with peritoneal lining) twists, causing decreased or absent blood flow to the testis and epididymis Prognosis prognostic variable favorable rapid time to surgery Presentation Symptoms primary symptoms in adolescents acute onset and severe pain in unilateral scrotum nausea vomiting in neonates blue and firm unilateral scrotal mass Physical exam inspection high riding testis erythema and swelling tenderness to palpation absent cremasteric reflex Imaging Doppler ultrasound indications if testicular torsion is suspected but not confirmed with physical exam and history findings decreased or absent blood flow Studies Urinalysis to rule out epididymitis Diagnostic criteria diagnosed by history and physical exam diagnosis confirmed only during surgery Differential Epididymitis positive cremasteric reflex Treatment Operative orchiopexy (bilateral) indications within 24 hours of disease onset 4-8 hour window before there is permanent damage from ischemia bilateral orchiopexy should be performed as contralateral testis is also at risk for future torsion outcomes 90-100% with viable testes if within 6 hours 50% if within 12 hours <10 % if after 24 hours orchiectomy indications if testis is not viable Non-operative manual detorsion indications if surgery is not available or delayed Complications Testicular ischemia Infertility or subfertility