Scrotal Abnormalities Research Articles

Large Epididymal Cyst: A Tale of Three Testes

Background: An epididymal cyst is a benign cystic structure that develops from the epididymis, typically due to a blockage in the epididymis, resulting in fluid accumulation. These cysts are generally harmless and noncancerous. Case Presentation: We examine the case of a 30-year-old male referred by the Psychiatry department for an assessment of the inguinal scrotal region, due to his belief that he had three testicles. Physical examination revealed an extratesticular, fluctuant, and cystic swelling easily palpable and distinct from the body of the left testis. Ultrasound findings showed a 2.3 x 1.7 cm fluid-filled lesion at the head of the epididymis. Intervention: Following a psychiatric evaluation, the patient underwent surgical excision of the cyst. Conclusion: The histopathological examination of the surgically removed cyst confirmed the diagnosis of an epididymal cyst, underscoring the importance of considering such benign conditions in differential diagnoses of scrotal abnormalities.

Advanced Sonographic Techniques in the Comprehensive Evaluation and Diagnosis of Male Infertility.

Background Infertility affects many couples, with male factors being responsible for over half of the cases. Male infertility can arise from various testicular illnesses, such as varicocele and cryptorchidism, as well as posttesticular disorders, like ejaculation abnormalities. Infertility is defined as the inability to conceive after 12 months of unprotected sexual activity or after six months for women over 35. Diagnostic techniques such as semen analysis and scrotal ultrasonography are done to evaluate conditions like varicocele and epididymo-orchitis. This study aims to assess the diagnostic utility of ultrasonography for male infertility and compare its findings with those from surgery and clinical care. Methodology All patients were referred to the Department of Radiology,Tertiary Care Hospital, South India, for transrectal and scrotal ultrasonography, using a high-frequency transducer with a frequency of 7.5 MHz and a color Doppler when necessary. The study included all male patients with infertility and abnormal semen analysis, as well as those with infertility accompanied by scrotal abnormalities detected during clinical examination. Patients were placed in the left lateral decubitus position for the transrectal ultrasonography examination. The testes and epididymis were thoroughly examined on both sides and compared regarding symmetry, size, texture, and vascularity. Results Varicocele was the most frequent anomaly detected by both clinical examination and ultrasonography. Ultrasound detected 30 cases of varicocele, whereas clinical examination diagnosed 15 cases. Hydrocele was identified in eight cases through clinical examination and in 15 cases through ultrasound. Epididymal cysts were found in five cases via clinical examination, while both clinical examination and ultrasonography discovered epididymitis in 10 cases. Overall, the number of anomalies detected by ultrasound was significantly higher than those found by physical examination, with a statistically significant p value of 0.001. Conclusion Transrectal ultrasound provides high-resolution imaging of the prostate, seminal vesicles, and distal vas deferens, which aids in diagnosing obstructive azoospermia. Imaging is a valuable supplement to clinical examination and laboratory studies for accurately identifying anatomy and abnormalities. Both transrectal and scrotal ultrasonography offer crucial information in diagnosing male infertility. Ultrasonography is more effective in identifying pathological abnormalities than clinical palpation.

Testicular and scrotal abnormalities in pediatric and adult patients.

Testicular and scrotal abnormalities can occur in children, adolescents, and adults. The lesions, often accompanied by pain and swelling/enlargement of the scrotum, can cause anxiety in patients and their parents. Regardless of age, proper diagnosis is based on adequate anamnesis and physical examination. Color Doppler ultrasound is the first-line test in the differential process of testicular and scrotal diseases. Testicular and scrotal lesions require differentiation for benign and malignant processes as well as therapeutic management, including urgent surgical intervention. The aim of this paper is to present the most common causes of testicular and scrotal abnormalities in pediatric and adult patients and to outline the symptoms and diagnostic and therapeutic management.

A novel technique in the management of crossed testicular ectopia in children

BackgroundCrossed testicular ectopia (CTE) is an extremely rare anomaly of urogenital development in which both testes are migrated and descend through a single inguinal canal, one or both testes may be ectopic in the abdomen, the inguinal region or descent to the hemi-scrotum with empty contralateral hemi-scrotum. The etiopathogenic mechanism of CTE is still unknown. CTE was classified into three types based on the associated findings. Most of the cases were found associated with other abnormality such as Persistent Mullerian Duct Syndrome, Inguinal hernia, Hermaphroditism, and other scrotal abnormality. The condition is mostly detected incidentally during repair of inguinal hernia or laparoscopic evaluation of impalpable undescended testis. We present our experience in management of seven cases with CTE including a novel technique named "Arabic eight figure orchiopexy". ConclusionsCTE should be considered in children presented with unilateral inguinal hernia or hydrocele with empty contralateral hemiscrotum. We present a novel technique in management of CTE named "Arabic eight figure orchiopexy".

Patient-Friendly Summary of the ACR Appropriateness Criteria: Newly Diagnosed Palpable Scrotal Abnormality.

Testicular cancer is most commonly a germ cell testicular tumor, which accounts for about 85% of all testicular tumors. Most men with testicular cancer are diagnosed early, before the cancer has spread outside of the testicle. Some men will have associated symptoms and seek medical care, whereas other men may have a lump on the testicle that they feel (palpate) or because one testicle appears or feels larger than the other.

The Frequency of Penile and Scrotal Abnormalities in Early Childhood Boys Attending Pediatric Mansoura University Hospital

The Frequency of Penile and Scrotal Abnormalities in Early Childhood Boys Attending Pediatric Mansoura University Hospital

Reduction of testosterone levels in Schistosoma haematobium- or Schistosoma mansoni-infected men: a cross-sectional study in two schistosomiasis-endemic areas of the Adamawa region of Cameroon

BackgroundThe incidence of schistosomiasis‐induced male reproductive dysfunction and infertility is probably underestimated compared to female genital schistosomiasis. This study aimed to investigate the impact of Schistosoma haematobium or S. mansoni infection on the reproductive function of men of reproductive age in Tibati and Wouldé, two endemic schistosomiasis areas in the Adamawa region of Cameroon.MethodsA total of 89 men of reproductive age (range 14–56 years) from two localities were enrolled in the study, with 51 in Tibati and 38 in Wouldé. Each participant was submitted to a questionnaire to document data on sociodemographic and stream contact behaviors. A medical examination was performed to measure the testes’ circumference and evaluate genital tract pathologies. Stool and urine samples were collected and screened for the presence of S. haematobium or S. mansoni ova. Blood serum was used to assess the levels of transaminases and testosterone.ResultsSchistosoma haematobium was present only in Tibati, with a prevalence of 31.37%. The S. mansoni prevalence was 3.92% at Tibati and 44.71% at Wouldé. The intensity of infection was 22.12 ± 9.57 eggs/10 mL for S. haematobium and 128.10 ± 3.76 epg for S. mansoni. Serum transaminase activity and the mean testicular circumference of Schistosoma-positive individuals were close to Schistosoma-negative individuals. However, the testes size was more prominent in S. mansoni-positive individuals than in S. haematobium-positive individuals (P < 0.05). The serum testosterone levels of S. haematobium- and S. mansoni-positive men were significantly reduced by 56.07% (P < 0.001) and 51.94% (P < 0.01), respectively, in comparison to those of Schistosoma-negative men. A significant and negative correlation was established between schistosomiasis and the low serum testosterone level. Male genital tract pathologies such as scrotal abnormalities, varicocele, nodular epididymis, inguinal hernia, and hydrocele were recorded in both Schistosoma-positive and Schistosoma-negative men. However, no significant link was established between schistosomiasis infection and these pathologies.ConclusionThese results demonstrated that infection with S. haematobium or S. mansoni is associated with low production of the reproductive hormone testosterone and may be a significant cause of male infertility.

The European Academy of Andrology (EAA) ultrasound study on healthy, fertile men: Scrotal ultrasound reference ranges and associations with clinical, seminal, and biochemical characteristics.

Scrotal color Doppler ultrasound (CDUS) still suffers from lack of standardization. Hence, the European Academy of Andrology (EAA) has promoted a multicenter study to assess the CDUS characteristics of healthy fertile men (HFM) to obtain normative parameters. To report and discuss the scrotal organs CDUS reference ranges and characteristics in HFM and their associations with clinical, seminal, and biochemical parameters. A cohort of 248 HFM (35.3±5.9years) was studied, evaluating, on the same day, clinical, biochemical, seminal, and scrotal CDUS following Standard Operating Procedures. The CDUS reference range and characteristics of the scrotal organs of HFM are reported here. CDUS showed a higher accuracy than physical examination in detecting scrotal abnormalities. Prader orchidometer (PO)- and US-measured testicular volume (TV) were closely related. The US-assessed TV with the ellipsoid formula showed the best correlation with the PO-TV. The mean TV of HFM was~17ml. The lowest reference limit for right and left testis was 12 and 11ml, thresholds defining testicular hypotrophy. The highest reference limit for epididymal head, tail, and vas deferens was 12, 6, and 4.5mm, respectively. Mean TV was associated positively with sperm concentration and total count and negatively with gonadotropins levels and pulse pressure. Subjects with testicular inhomogeneity or calcifications showed lower sperm vitality and concentration, respectively, than the rest of the sample. Sperm normal morphology and progressive motility were positively associated with epididymal head size/vascularization and vas deferens size, respectively. Increased epididymis and vas deferens sizes were associated with MAR test positivity. Decreased epididymal tail homogeneity/vascularization were positively associated with waistline, which was negatively associated with intratesticular vascularization. CDUS varicocele was detected in 37.2% of men and was not associated with seminal or hormonal parameters. Scrotal CDUS parameters were not associated with time to pregnancy, number of children, history of miscarriage. The present findings will help in better understanding male infertility pathophysiology, improving its management.

Erratum

Erratum

Prognostic values of shear wave elastography in adolescent boys with varicocele

Shear wave elastography is an ultrasound technique for non-invasive quantification of tissue stiffness. It was used in assessing testis elasticity in some scrotal abnormalities, such as undescended pediatric testes or adult varicocele testes. In this study, its usefulness in adolescent patients with varicocele was examined. The aim of this study was to quantify elasticity of testes with the use of elastography and comparison of the results with typical threshold values used in varicocele management in adolescent patients with varicoceles. In 30 patients with clinically diagnosed left varicoceles, quantitative 2D shear wave imaging of varicocele testes and contralateral ones were performed. The relationships between the grade of varicocele and elastography were calculated. The stiffness was 2.5±0.49kPa in testes with grade I of varicocele, 2.59±0.81 in grade II and 2.80±0.72kPa in grade III. In contralateral testes, it was respectivelygrade I 2.39±0.49kPa, grade II 2.41±0.61kPa, and grade III 2.42±0.85kPa. The statistical significance was close to importance in grade III (P=0.153). There was a statistically significant difference between elastography results in patients with volume difference over 20%. In testes with varicocele, it was 2.77±0.75kPa and in contralateral testes, 2.37±0.65kPa (P<0.05). In patients with testis volume difference between 0 and 20%, elastography results were comparable, and it was 2.45±0.57kPa in testes with varicocele and 2.44±0.61kPa in contralateral testes (Table). Ultrasound is currently the most widely used imaging technique for the assessment of varicocele, but its role in the diagnostic algorithm is still controversial. Therefore, many attempts are made to determine the manifestations of testicular damage that precede morphological deterioration, which could increase the importance of imaging techniques in treatment planning. The changes of tissue elasticity due to varicocele seem to confirm the need of surgery in patients with testis volume difference more than 20% and in grade III of varicocele (Table). In case of validation of diffuse testis changes, they could indicate the need for surgery also in other stages.

Sonography of scrotal abnormality among subfertile and fertile males in Abuja, Nigeria

Background Male factor infertility in Nigeria accounts for up to 50% of all infertility cases, most of which happen as a result of abnormalities of testicular function and infection. Male factor can be assessed by seminal fluid analysis; however scrotal ultrasound is now increasingly being used to evaluate males with infertility. Objectives The objective of this study is to determine the spectrum of scrotal abnormalities on ultrasound in sub-fertile and fertile men. Patients and method This was a prospective study which spanned for a period of eight months (January–August 2016). A total of 270 patients were included in the study comprising of 180 consecutive males who were being evaluated for sub-fertility and 90 apparently normal fertile adults who underwent a scrotal scan at the radiology department of University of Abuja Teaching Hospital using 7.5 MHz of EMP G70, China scan machine with Doppler facility. All patients were scanned in supine and upright position in both B and Doppler modes and any scrotal abnormalities were recorded. Result The mean age of sub-fertile and fertile subjects studied was 29 ± 11.4 years and 34 ± 16.3 years, respectively. Scrotal abnormalities were commoner in the sub-fertile group compared to the fertile group with a prevalence rate of 45.0% and 32.2%, respectively. Varicocele was the most common finding in both groups with a higher prevalence rate of 50.6% in the sub-fertile group compared to 48.3% in fertile group. This distribution was statistically significant (P = 0.000). Varicocele was observed more on the left. Hydrocele was the second most common finding in both groups. Conclusion The role of scrotal scan in evaluating infertility cannot be overemphasized. In this study, ultrasound scan was used to evaluate 45.0% of sub-fertile subjects with scrotal abnormalities. Ultrasound being non-invasive and readily available should be considered as an important investigation in accessing cases of infertility.

Transverse testicular ectopia: A surgical surprise

Crossed Testicular Ectopia / Transverse Testicular Ectopia is a rare but well known congenital anomaly in which both gonads migrate towards same Hemiscrotum. Most of the cases were found associated with other abnormality such as Persistent Mullerian Duct Syndrome, Inguinal hernia, Hermaphroditism and other scrotal abnormality. Most of the cases reported in literature are children with very few reports in adults. About 100 cases of Transverse Testicular Ectopia were reported in literature till now. We report a case of Transverse Testicular Ectopia in a 42 year old gentleman presented with partially reducible Left Inguinal Hernia with non-palpable Right Testis. On exploration, one testis with rudimentary Uterus and bilateral rudimentary Fallopian tubes were present in Left Inguinal Canal while another testis in Left Hemiscrotum. Castration with left hernioplasty done as the patients is adult.

Scrotal Calculi: A Rare Ultrasonography Finding

Abstract: Scrotal calculi, also known as scrotal pearls, are benign incidental extra testicular macro-calcifications within the scrotum. Hydrocele and repeated micro-trauma may be risk factors for development of scrotal calculi. They are usually of no clinical significance but literature data suggest their role in scrotal pain. Keywords: Scrotal calculi; Ultrasonography; Hydrocele Introduction Scrotal calculi correspond to the presence of freely floating or located calcifications lying between the layers of the tunica vaginalis of the testes [1]. It’s a rare discovery with a reported incidence ranging between 1.5% and 3% [1,2]. Intrascrotal calculi was first found by Kickham during surgery in 1935 and he described it as a “fibrinoid loose body” or “scrotal pearl” Case Presentation: We report the case of a 38 years old patient with no specific medical history complaining about an intermittent scrotal pain. Clinical examination found a swelling of the right spermatic cord without cough impulse. No other abnormalities of genitalia were noticed. Scrotal ultrasonography found both testis of normal size with the presence of 0.73 × 0.32 cm mobile scrotal calculi in the right hemiscrotum associated a small hydrocele (Figure 1A and 1B). A right epidydimal cyst of 0.83 × 0.66 × 1.16 cm was also found (Figure 2). The patient received analgesic treatment with good evolution and was kept under close follow-up. Discussion: Scrotal calculi are mostly incidental finding in patients during scrotal ultrasound examination and easily recognized given the hyper echoic nature of the calcification which causes a discrete acoustic shadow. Detection rate of scrotal calculi is gradually increasing since they are well visualized with the application of high-frequency ultrasound. They can also be detected during surgery, on self-palpation of the testis by patients. The etiology of scrotal calculi is unclear. They may develop as a sequela to trauma or inflammatory diseases affecting the scrotum or from detached portions of the appendices testis or epididymis after torsion or infarction [1,4]. Literature data reports a high association between hydrocele and scrotal calculi suggesting its role in the genesis of scrotal calculi by crystallization of contains of the scrotal fluid. Tan et al. reported an association of hydrocele and scrotal calculi exceeding. Hydrocele was the most common additional scrotal abnormality (29.8%) in Aslan et al. study. Frauscher et al. reported scrotal calculi as the most common diagnosed scrotal abnormality with a high incidence of 81% suggesting the role of repeated chronic micro-trauma of the scrotal contents in the genesis of scrotal calculi. Patients with an association of hydrocele and scrotal calculi exceeded 50% in Tan et al. study. Hydrocele was the most common additional scrotal abnormality (29.8%) in Aslan et al. study. Clinical significance of scrotal calculi is uncertain but some authors suggested their participation in scrotal pain given the presence of scrotal pain in patients with scrotal calculi who had no know additional scrotal abnormalities [2-5]. This pain has been explained by the movement of calculi in the fluid between the layers of the tunica vaginalis which may irritate the surrounding soft tissue, resulting in occasional pain. To date, no information is available in the literature about the results of chronic irritation due to scrotal calculi.

The Value of Routine Scrotal Color Doppler Ultrasonography in the infertile male

Clinical assessment of scrotal contents in patients with infertility has relied mainly on physical examination.Color Doppler ultrasonography (US) is generally not performed as a routine examination. However, physical examination might miss many abnormalities readily detected by US, including testicular tumor and testicular microlithiasis (TM). We assessed the value of scrotal color Doppler ultrasonography as a routine examination in infertile men compared with findings by physical examination. Scrotal Color Doppler ultrasonography was performed in 314 infertile men with a mean age of (25±5.4) years to detect intrascrotal abnormalities. Findings were compared with those of physical examination. Intrascrotal abnormalities were detected by ultrasonography in 86.6% of patients. Of 374 abnormalities, 31% were undetected by physical examination. Left varicocele was found in 234 patients (74%); testicular microlithiasis in 10 (3.1%);epididymal cyst in 23 (7.3%); right varicocele in 7(2.2%); and testicular cysts in 2 (0.6%). One occurrence (0.3%) was found for testicular tumor, hypoechoic small testicles in 11(3.2%), and hydrocele in 45(14.3%).Compared to ultrasonography, sensitivity in detecting left varicocele by physical examination was 77%. Sensitivity of physical examination in detecting left varicocele compared with to US was decreased as grade of left varicocele decreased. The routine Color Doppler ultrasonography is valuable for diagnosing scrotal abnormalities in infertile men,frequently detecting non-palpable lesions that were missed by physical examination.

A Cross Sectional Study of the Prevalence of Preputial and Penile Scrotal Abnormalities among Clients Undergoing Voluntary Medical Male Circumcision in Soweto, South Africa.

ObjectiveMedical device use is currently approved for males without preputial or major penile scrotal abnormalities for voluntary medical male circumcision (VMMC). We determined the prevalence of preputial abnormalities at a busy VMMC centre in Soweto, South Africa.MethodsThis was a cross-sectional record review at a high-volume VMMC centre in South Africa. We collated pre-circumcision demographic and genital examination findings from clients 8 years and older who had undergone VMMC from 01 May 2013 to 30 April 2014. Logistic regression was used to determine factors associated with preputial abnormalities.FindingsDuring the review period, 6861 circumcisions were conducted and 37.1% (n = 2543) were 8–13 year olds. Median age was 15 years (IQR: 12–23 years). Fifteen percent (n = 1030) had preputial abnormalities or major penile scrotal abnormalities. Age-specific prevalence of preputial or major genital abnormalities were 27.3%, 10.6% and 6.0% in 8–13, 14–18 and > 18 year olds respectively. The odds of preputial or major penile scrotal abnormality were higher in younger clients aged 8–13 years (OR = 5.9; 95% CI = 4.8–7.1) and 14–18 years (OR = 1.9; 95% CI = 1.5–2.4) compared to older clients above18 years and in those testing for HIV outside our clinic network (OR = 1.9; 95% CI = 1.4–2.7).ConclusionThe high prevalence of preputial and penile scrotal abnormalities observed suggests a need for VMMC sites to provide for both open surgical and devices methods in the provision of VMMC services. This is especially so among young male subjects presenting themselves for VMMC services at the various sites being developed in sub Saharan African countries.

Ultrasonography of the scrotum in adults.

Ultrasonography is the ideal noninvasive imaging modality for evaluation of scrotal abnormalities. It is capable of differentiating the most important etiologies of acute scrotal pain and swelling, including epididymitis and testicular torsion, and is the imaging modality of choice in acute scrotal trauma. In patients presenting with palpable abnormality or scrotal swelling, ultrasonography can detect, locate, and characterize both intratesticular and extratesticular masses and other abnormalities. A 12-17 MHz high frequency linear array transducer provides excellent anatomic detail of the testicles and surrounding structures. In addition, vascular perfusion can be easily assessed using color and spectral Doppler analysis. In most cases of scrotal disease, the combination of clinical history, physical examination, and information obtained with ultrasonography is sufficient for diagnostic decision-making. This review covers the normal scrotal anatomy as well as various testicular and scrotal lesions.

Males' Awareness of Benign Testicular Disorders: An Integrative Review.

Disorders that affect the testes can range from painless and benign to debilitating and life threatening. Despite the availability of literature on the etiology, diagnosis, and treatment of benign testicular disorders (BTD), very little is known about men's awareness of these conditions. The aim of this review was to extract and analyze evidence from studies that explored males' awareness of BTD. Four e-databases (CINAHL, MEDLINE, PsychINFO, and PubMed) were thoroughly searched and four articles met the review inclusion criteria. The quality of the included studies was appraised and data were extracted and cross-checked using a standardized data extraction table. It was determined that participants lacked education about testicular self-examination and scrotal signs and symptoms which contributed to their lack of awareness of BTD. Help seeking in the event of scrotal abnormalities was suboptimal which is alarming given the acuteness of some BTD such as testicular torsion. Individuals who are at risk for health disparities were underrepresented in the reviewed literature. Findings from this review highlight the need to address barriers to BTD knowledge and help seeking. This could be achieved through making use of past interventions that succeeded in increasing men's awareness of testicular cancer such as university campaigns and mass media. From a practical standpoint, clinicians must be encouraged to educate young men about BTD. This could be attained through tailoring creative educational interventions that are sensitive to the needs of individuals who are at risk for health disparities.

Testicular Cancer Awareness and Screening Practices: A Systematic Review.

To critically appraise empirical evidence gathered from studies that (a) explored men's knowledge, awareness, and attitudes toward testicular cancer (TC) and its screening; (b) addressed their testicular self-examination (TSE) practice; and/or (c) highlighted barriers and facilitators to this practice. . MEDLINE®, CINAHL®, and EMBASE®. . 25 articles met the inclusion criteria. Knowledge deficits regarding TC and its screening were seen. Participants who did not perform TSE often were uninformed about this practice. The majority of men perceived TC education as a positive step toward raising awareness about this malignancy. . Very few men were informed about TC and TSE. Future studies should include valid and reliable tools to assess TC knowledge and screening, address the means through which TC knowledge is delivered, explore the individual's experience with TC screening, and focus on TC awareness and screening among minority groups. . Although regular screening for TC is a controversial issue, nurses should encourage young men to seek medical attention in the event of discovering scrotal abnormalities.

A fast-growing, painless, solid scrotal mass

The history and physical examination of an adolescent male are critical to early detection of scrotal abnormalities. Although rare, paratesticular rhabdomyosarcoma grows quickly and can be life-threatening. This article focuses on the importance of prompt recognition, diagnosis, and appropriate management of paratesticular rhabdomyosarcoma in an adolescent.

Clinical analysis of testicular torsion with the primary symptom of abdominal pain in adolescents and boys

Objective To evaluate the characteristics of the testicular torsion patients with the first symptom of acute abdominal pain. Methods From October 1998 to May 2014, 8 adolescent or boys with testicular torsion presenting acute abdominal pain instead of scrotal pain as their primary symptom were retrospectively reviewed. The average age was 12 (3-16) years. An acute abdominal pain presented firstly in all cases, which accompanied by nausea and vomiting in 4 cases, groin pain in 2 cases, fever in 1 case. In genital examination, the scrotum skin was red and swollen, while the testis was in transverse position and tenderness. The testicular and homolateral abdominal pain got worse when we pulled the involved testis. Doppler ultrasound examination revealed that the blood supply of the involved testis decreased or disappeared. Results In the 8 cases, 5 cases were not examined their testicles or scrotum during the first evaluation, which were found the testicular necrosis during the following exploratory surgery, and orchidectomy was performed. In the other 3 cases, external genital were examined during the first evaluation, and the scrotal and testicular abnormalities were detected. Doppler ultrasonography showed abnormality in testicular blood supply. Testicular torsion was proved during the emergent operation, and the 3 testes were salvaged. The mean duration time from symptom onset to operation was 4 h in the salvaged group, while the average time was 28 h in the orchiectomy group. The mean follow-up time was 18 (10-36) months. In the 3 cases whose testis was saved, 1 affected testis was atrophied, and the blood supply of the other two was good. No severe complications occurred in the other 5 cases. Conclusions Testicular torsion should be considered in adolescents and boys with acute lower abdominal pain. The routine external genital examination should be performed when a boy or adolescent complains of abdominal pain. Key words: Testicular torsion; Adolescent and children; Acute abdominal pain; Acute scrotal pain