Summary: Immediate urological referral indicated
Advice: Immediate urological referral indicated.
Refer To: On-call urologist
Torsion of the testis
This is a genuine urological emergency and the diagnosis is best confirmed by surgical exploration. Typically the condition occurs in children and teenagers, but it can occur at any age.
A severe episode of torsion is often preceded by intermittent episodes of testicular pain, commonly occurring during the night.
Surgical exploration within 4 hours of the onset of the pain is associated with the best chance of testicular preservation. A delay of 12 hours is associated with a 50% rate of testicular loss and, after 24 hours, almost all testes are infarcted and non-viable.
Urgent exploration will be performed with untwisting and fixation of both testes.
Torsion of a testicular appendage
This is less urgent but, usually, indistinguishable from torsion of the testis and should also be managed by emergency admission.
Epididymitis in children
Acute epididymitis and epididymo-orchitis in children are extremely rare.
Children with acute scrotal inflammation should not be treated with antibiotics but referred urgently for urological assessment. Scrotal exploration is normally necessary, even if epididymitis is suspected.
Other rarer disorders (e.g. idiopathic scrotal oedema) should not be diagnosed without urological referral.