The following symptoms and complaints may indicate testicular torsion (testicular torsion):
Leading symptoms
- Unilateral (one-sided), sudden, severe, rapid-onset pain:
- Pain radiates to the inguinal canal and lower abdomen (approximately 50% of patients have these symptoms)
- Swelling of the testis/upstanding testis (Brunzel’s sign: fixed, painful, horizontal upstanding of the testis in the presence of testicular torsion).
- Dark blue to black discoloration of the testis.
Associated symptoms
- Abdominal pain (abdominal pain) with nausea (nausea)/ about 40% vomiting.
- Sweating
- Tachycardia – heartbeat too fast: > 100 beats per minute.
If the testicle is not completely turned, the symptoms may be less intense and intermittent.
Caveat. Newborns and infants are likely to have little or no pain.
TWIST score
The TWIST score is an effective diagnostic tool for assessing the likelihood of testicular torsion:
| Clinical findings | Points |
| Testicular swelling | 2 |
| Hard testicle | 2 |
| Kremer the reflex not triggerable | 1 |
| Undescended testicle | 1 |
| Nausea/vomiting | 1 |
Evaluation
- ≥ 5 points: High-risk group (positive predictive value 100%), i.e., the patient can be admitted to the operating room immediately without diagnostic imaging
- 3-4 points: Medium risk group: scrotal sonography required.
- ≤ 2 points: Low-risk group (negative predictive value 100%), i.e. no scrotal sonography is required.
Other authors set the upper threshold at 6 and the lower threshold at 0 points.
