# Testicular torsion - Category: acute - Review status: reviewed (every claim checked against a document named on this page) - Sources: ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class GD99.03 - condition scope only, no dose · No dose - referral pathway, no medicine given in primary care · Testicular Torsion - StatPearls - NCBI Bookshelf - https://www.ncbi.nlm.nih.gov/books/NBK448199/ · Testicular torsion - disease-level clinical article (testicular-torsion-full.txt) - Verified date: 2026-08 ## Verified against - No dose - referral pathway, no medicine given in primary care - Testicular torsion - disease-level clinical article (testicular-torsion-full.txt) ## Treatment metadata - SURGICAL EMERGENCY - send now (Recognition & Referral) ## Complete treatment card ```text TESTICULAR TORSION Sources: ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class GD99.03 - condition scope only, no dose · No dose - referral pathway, no medicine given in primary care · Testicular Torsion - StatPearls - NCBI Bookshelf - https://www.ncbi.nlm.nih.gov/books/NBK448199/ · Testicular torsion - disease-level clinical article (testicular-torsion-full.txt) Review status: REVIEWED against 2 sources listed above (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (3) - Torsion classically causes sudden one-sided scrotal pain that is constant or intermittent but does not change with position [testicular pain] - Nausea or vomiting often accompanies the pain [nausea · testicular pain · vomiting] - Lower abdominal or groin pain can occur, and may even be the main complaint instead of scrotal pain [abdominal pain · groin pain · lower abdominal pain] SIGNS - what you find (4) - The testicle may sit abnormally rotated and high, appearing swollen and red, with an absent cremasteric reflex - The cremasteric reflex is a less reliable sign than once believed, especially in infants under one year old - Pain relief with testicle elevation, the Prehn sign, does not reliably predict or exclude torsion [testicular pain] - Appendage torsion, unlike true torsion, shows point tenderness near the epididymal or testicular head, a discrete tender nodule, or a blue dot sign [local tenderness · skin nodule] TESTS (5) - The TWIST score adds points for a hard testis, swelling, nausea or vomiting, an absent cremasteric reflex, and a high-riding testis - A high TWIST score can go straight to surgery, while a low score prompts an ultrasound first - Scrotal ultrasound for torsion runs about 93% sensitive and 100% specific - A torsed testicle often has an accompanying hydrocele and reduced blood flow on color or power Doppler - Pyuria on urinalysis points toward epididymitis, orchitis, or a UTI, but does not exclude torsion IF NOT THIS - what else fits (7) - Testis tumor - Epididymitis - Hydrocele - Traumatic hematoma - Orchitis - Inguinal hernia is also considered in the differential for acute scrotal pain - Testicular necrosis from another cause besides torsion is also on the differential Source StatPearls "Testicular Torsion" - disease-level clinical article Status traced to the source above 1. SURGICAL EMERGENCY - SEND NOW (RECOGNITION & REFERRAL) [1st line] Adult A true surgical emergency, and one of the few conditions here where the right answer is to send the patient straight out of the door. The article is blunt: surgery is the only treatment, and testicular viability falls away sharply once 6 hours have passed since the symptoms began, which is why the diagnosis has to be early. Do not wait for reassuring imaging - where clinical concern is high, get the urological surgeon on the phone at once, because any delay can end in a necrotic testis and its loss. The window for surgery and salvage is usually the first 6 hours from the onset of pain. The operation is detorsion with fixation of BOTH sides: the contralateral testis is always secured in the same sitting, so that it cannot torse later. Keep the patient nil by mouth on the way - nothing to eat and nothing to drink, ready to go to theatre. - Send now - minutes matter Peds Children follow the same pathway: recognise and refer. No primary-care medicine is implied. Source No dose - referral pathway, no medicine given in primary care Why A true surgical emergency, and one of the few conditions here where the right answer is to send the patient straight out of the door. The article is blunt: surgery is the only treatment, and testicular viability falls away sharply once 6 hours have passed since the symptoms began, which is why the diagnosis has to be early. Do not wait for reassuring imaging - where clinical concern is high, get the urological surgeon on the phone at once, because any delay can end in a necrotic testis and its loss. The window for surgery and salvage is usually the first 6 hours from the onset of pain. The operation is detorsion with fixation of BOTH sides: the contralateral testis is always secured in the same sitting, so that it cannot torse later. Keep the patient nil by mouth on the way - nothing to eat and nothing to drink, ready to go to theatre. Caution RED FLAG - Do not give analgesia before urology has assessed the patient, since it can mask symptoms and delay diagnosis. The article puts the same instruction on the nursing staff: nothing for the pain until the urologist has seen him, because the analgesia hides the very signs the diagnosis rests on and pushes it back (Testicular Torsion - StatPearls - NCBI Bookshelf, NBK448199). This card carries no drug row and it is the only card in this app where WITHHOLDING a drug is the instruction. There is no analgesic row, no antibiotic row and no anti-emetic row, because the article's one sentence about pain medication says to hold it until the urologist has seen the patient. The clock is the prognosis. Present inside the first 6 hours and the testis is saved close to 100% of the time; leave it longer than 12 to 24 hours and the figure falls below 50%. If urology genuinely cannot be reached, manual detorsion is a bridge, not a treatment. The article's method: turn the affected testis from medial to lateral, like opening a book, through 180 degrees, then ask whether the pain has eased (Testicular Torsion - StatPearls - NCBI Bookshelf, NBK448199). The patient still goes to theatre afterwards. RED FLAG - Sudden severe scrotal pain, a high-riding or horizontally lying testis, an absent cremasteric reflex, or nausea or vomiting with scrotal pain. Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)