How is testicular torsion differentiated from epididymitis and orchitis?

Updated: Oct 30, 2020
  • Author: Oreoluwa I Ogunyemi, MD; Chief Editor: Edward David Kim, MD, FACS  more...
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Torsion of the testicular or epididymal appendage usually occurs in boys aged 7-12 years. Systemic symptoms are rare. Usually, localized tenderness occurs, but only in the upper pole of the testis. Occasionally, the blue dot sign (ie, a tender nodule with blue discoloration on the upper pole of the testis) is present in light-skinned boys.

Epididymitis, orchitis, and epididymo-orchitis conditions most commonly occur from the reflux of infected urine or from sexually acquired disease caused by gonococci and Chlamydia. Patients occasionally develop these conditions following excessive straining or lifting and the reflux of urine (chemical epididymitis).

These conditions may be secondary to an underlying congenital, acquired, structural, or urologic abnormality and are often accompanied by systemic signs and symptoms associated with urinary tract infection. Pyuria, bacteriuria, or leukocytosis is possible. A complete urologic evaluation (ie, renal sonography, urodynamic study) is necessary in prepubertal boys with acute epididymitis.

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