The management of acute testicular pain in children and adolescents

The bottom line

• The acute scrotum is a medical emergency because any unnecessary delay can result in irreversible damage to the testis

• Key elements in the history are the age of the patient and the duration and onset of symptoms

• Testicular torsion is most common in neonates and post-pubertal boys

• If testicular torsion is suspected urgent exploration and detorsion are key to maximise testicular salvage rates

• Although ultrasonography is useful, it should not delay surgical exploration if testicular torsion is suspected. A small but real, negative exploration rate is acceptable to minimise the risk of missing a critical surgical diagnosis

Sources and selection criteria

We searched PubMed and Clinical Evidence online using the search terms “acute scrotum”, “testicular torsion”, “epididymo-orchitis”, and “torted testicular appendage”. Historically, the management of the acute scrotum has changed little, and much of the data reviewed were case series and best expert opinion from book chapters. In addition we consulted up to date national and international guidelines published by the European Association of Urology and the Royal College of General Practitioners.