Excellent salvage rates are expected with < 6 hours of symptoms,
but salvage declines rapidly thereafter.
常見 15- 25 y/o
Sudden onset, cramping pain, testis axis 改變 ( Transverse lying )
Negative Prehn's sign ( No lifting sign ) : 睪丸上提無法緩解疼痛
可和 Epididymo - orchitis 做 D/D : Prehn's sign + (上提睪丸會緩解疼痛)
The presence of vomiting
makes the diagnosis of testicular torsion more likely.
Relief of pain with elevation of the affected testicle
(Prehn's sign–positive for epididymitis)
does not reliably distinguish torsion from epididymitis.
The most sensitive finding in excluding testicular torsion is the unilateral
presence of the cremasteric reflex, but the sensitivity ranges from 73% to 96%.
The absence of an ipsilateral cremasteric reflex is a nonspecific finding
and may be associated with scrotal inflammation from any cause
Testicular appendages
Appendix testis, appendix epididymis, paradidymis (organ of Giraldes), and vas aberrans
Prepubertal boys(9-11 y/o)
classically lack the systemic symptoms of nausea and vomiting
Pain localized to the upper pole of the testis or epididymis
A blue spot may be observed through the scrotal skin—the blue dot sign
If the diagnosis can be ensured and normal intratesticular blood flow to the involved testis
confirmed by color Doppler US, surgical exploration is not necessary.
Torsion of an appendage is usually self-limiting and best managed with analgesics, bed rest,
supportive underwear, and reassurance, with the expected symptom resolution within 3 to 5 days.
The initial attempt should include one and
one-half rotations (540 degrees).
Any relief of pain is a positive end point,
and the success of the maneuver can be assessed with Doppler US,
worsening of the patient's pain
suggests that detorsion should then be done in the opposite direction (one third of cases)
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