Adult testicular torsion

Q: 19 years old college student presented to the Emergency Room with acute scrotal pain. The surgical ICU team has been called. Testicular torsion is suspected. In testicular torsion cremasteric reflex would be? (select one)

A) positive

B) negative

Answer: B

The cremasteric reflex is incited by stroking the ipsilateral thigh of the troubled site of the testis. If the testis does not pull up, the test is considered negative, and a presumptive diagnosis of testicular torsion should be made. Another important aspect of a physical exam in testicular torsion is to look for bell clapper deformity with a high-riding testis. Profound testicular swelling is very common. Diagnosis should be confirmed with scrotal ultrasound as soon as possible since testicular torsion is a urologic emergency. 

A delay of a few hours may cause testicular nonviability up to the extent that if a surgical route is not available, manual detorsion should be performed.

#urology

#surgical-critical-care

References:

1. Rabinowitz R. The importance of the cremasteric reflex in acute scrotal swelling in children. J Urol 1984; 132:89.

2. Kutikov A, Casale P, White MA, et al. Testicular compartment syndrome: a new approach to conceptualizing and managing testicular torsion. Urology 2008; 72:786.

3. Cummings JM, Boullier JA, Sekhon D, Bose K. Adult testicular torsion. J Urol 2002; 167:2109.