Patient handout

Testicular torsion (time-critical scrotal emergency, <6 h salvage window)

PRODUCTION

1. Your condition

This handout is for testicular torsion (time-critical scrotal emergency, <6 h salvage window). Your care team identified this based on: sudden severe unilateral scrotal pain (aua 2017).

Other reasons your team may use this plan: scrotal pain with nausea / vomiting (high specificity; barbosa 2013 twist); adolescent male with isolated lower-abdominal pain — examine scrotum (aua 2017); prior episodes of intermittent torsion / detorsion (aua 2017).

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
morphine	0.1 mg/kg IV (typical 4–10 mg adult; weight-based 0.05–0.1 mg/kg pediatric)	IV	q3–4h PRN	Severe acute pain (AUA 2017)
fentanyl	1 µg/kg IV (typical 25–100 µg adult)	IV	q5–15 min PRN	Short-acting; preferred for titration (AUA 2017)
ondansetron	4 mg IV (peds 0.15 mg/kg, max 4 mg)	IV	q8h PRN	Symptom control (AUA 2017)
Lactated Ringer solution	500–1000 mL bolus + maintenance (peds: weight-based)	IV	continuous	Pre-op resuscitation; multi-ingredient balanced crystalloid (no single-ingredient RxCUI) (AUA 2017)
acetaminophen	15 mg/kg PO/IV (max 1 g/dose adult)	PO/IV	q6h, max 4 g/day adult	Opioid-sparing (AUA 2017)

Plan: Testicular torsion — perioperative supportive care + surgical pathway (AUA 2017)

3. When to call your provider

Contact your care team if any of the following happen:

New scrotal pain → STAT ED — pexy failure or contralateral torsion (rare but possible) (AUA 2017)
Abnormal semen analysis → reproductive endocrinology referral (Arap 2015)
PHQ-9 ≥15 OR suicidal ideation → urgent psychiatric referral (AUA 2017)
Hormone deficiency on 6-mo panel → endocrinology + consider testosterone replacement counselling

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

Symptom onset ≤6 h — salvage rate ~95% with prompt exploration (Barbosa 2013; AUA 2017)
Symptom onset 6–12 h — salvage rate ~70%; still emergent OR (AUA 2017)
Symptom onset 12–24 h — salvage rate ~20%; OR + explicit counselling on orchiectomy probability (AUA 2017)
Symptom onset >24 h — testicular death likely; salvage <10% (AUA 2017)
Newborn / first-week-of-life hard, discoloured, painless scrotal mass — extravaginal torsion (typically antenatal) (EAU paediatric urology; AUA 2017)
High-resolution scrotal POCUS shows absent intratesticular arterial flow with or without whirlpool sign of cord (Friedman 2017)
TWIST score 5–7 OR sudden severe scrotal pain + N/V + absent cremasteric reflex + high-riding testis (Barbosa 2013)(life-threatening)
Bilateral pain or absent flow on both sides (AUA 2017)(life-threatening)
Adolescent boy with isolated lower-abdominal pain — examine genitalia (AUA 2017)
Trauma + scrotal pain with concern for torsion vs rupture (AUA 2017)

5. Follow-up

Outpatient urology 1–2 wk + 6 wk; semen analysis 3–6 mo (post-orchiectomy or unilateral pexy + family planning); psychological support if orchiectomy; fertility / hormone discussion; activity restriction 4–6 wk; contralateral fixation at later date if not done at index operation (long-term fertility data per Arap et al)

6. Sources

Guideline: TWIST clinical scoring system (Barbosa J Urol 2013) + POCUS for paediatric testicular torsion meta-analysis (Mori EMJ 2022) + color-Doppler US accuracy & clinical predictors (Liang AJR 2013) + time-dependent testicular salvage (Preece J Pediatr Urol 2017)