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Testicular torsion and the acute scrotum: current emergency management

Ta, Anthony; D’Arcy, Frank T.; Hoag, Nathan; D’Arcy, John P.; Lawrentschuk, Nathan

European Journal of Emergency Medicine: June 2016 - Volume 23 - Issue 3 - p 160–165
doi: 10.1097/MEJ.0000000000000303

The acute scrotum is a challenging condition for the treating emergency physician requiring consideration of a number of possible diagnoses including testicular torsion. Prompt recognition of torsion and exclusion of other causes may lead to organ salvage, avoiding the devastating functional and psychological issues of testicular loss and minimizing unnecessary exploratory surgeries. This review aims to familiarize the reader with the latest management strategies for the acute scrotum, discusses key points in diagnosis and management and evaluates the strengths and drawbacks of history and clinical examination from an emergency perspective. It outlines the types and mechanisms of testicular torsion, and examines the current and possible future roles of labwork and radiological imaging in diagnosis. Emergency departments should be wary of younger males presenting with the acute scrotum.

aUrology Unit, Department of Surgery, University of Melbourne, Austin Health

bOlivia Newton-John Cancer Research Institute

cPeter MacCallum Cancer Centre, Melbourne

dEmergency Department, Austin Health, Heidelberg, Victoria, Australia

Correspondence to Nathan Lawrentschuk, MB, BS, PhD, FRACS, Urology Unit, Department of Surgery, University of Melbourne, Austin Health, Australia Tel: +61 9496 5000; fax: +61 9457 5829; e-mail:

Received April 1, 2015

Accepted July 6, 2015

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