Testicular torsion in the pediatric age group: diagnosis and treatment.

PURPOSE: To review and update several aspects of testicular torsion. INCIDENCE: The relative incidence of testicular torsion, torsion of testicular appendix and epididymo-orchitis is variable and depends on mode of diagnosis and patients' age. AGE: Testicular torsion can occur at any age. The peak is in adolescents below the age of 18 years. SYMPTOMS: Classical symptoms are not always present. Range of duration is varied. Nausea and vomiting are positive predictive value for testicular torsion. PHYSICAL EXAMINATION: Main findings predicting testicular torsion are absence of cremasteric reflex and diffuse tenderness. IMAGING: Color Doppler Ultrasound can assess in equivocal and low clinical suspicious conditions for testicular torsion. NEONATAL TORSION: There are two conditions in this age group; the prenatal that urgent exploration is in controversy and postnatal that urgent surgery is required. LATE OUTCOME: Early salvage rate and late atrophy depends on duration and degree of torsion. MEDICOLEGAL: Testicular torsion is an active area of malpractice litigation. Late presentation and atypical presentations do not affect the medicolegal outcome.