Approach to the Acute Scrotum

Key points

• • Testicular torsion: sudden severe pain, a high-riding testis and an absent cremasteric reflex - explore within 6 hours.
• • Epididymo-orchitis: more gradual, relieved by elevation, often with urinary symptoms.
• • Torsion of a testicular appendage (blue-dot sign) and a strangulated hernia also cause an acute scrotum.
• • If torsion cannot be excluded, operate - do not wait for imaging.