• Michael Boettcher, Thomas Krebs, Robert Bergholz, Katharina Wenke, Daniel Aronson, and Konrad Reinshagen.
• Department of Paediatric Surgery, UKE Medical School, Hamburg, Germany.
• BJU Int. 2013 Dec 1;112(8):1201-6.

ObjectiveTo test the clinical and sonographic predictors of testicular torsion (TT) with the aim of reducing negative exploration rates.Patients And MethodsWe performed a prospective study of all boys treated for 'acute scrotum' at our institute between January 2001 and April 2012 and clinical findings were documented. If available, ultrasonography (US) was added to the diagnostic evaluation. A prediction of the diagnosis was based on clinical and sonographic features, and was followed by surgical exploration in all patients.ResultsA total of 104 patients were included in the 16-month period of the study. No single finding excluded TT. The clinical features (pain <24 h, nausea/vomiting, abnormal cremasteric reflex, high position of the testis) appeared predictive (100% sensitivity) and the clinical scoring system was proven to be reliable, reducing the negative exploration rate by >55%. Ultrasound predictors alone were not able to identify all boys with TT.ConclusionsIt is safe to refrain from routine surgical exploration in every child with acute scrotum if the clinical score is applied, which results in a marked reduction of negative explorations. A reliable diagnosis could not be obtained based on US alone. As scrotal US is unpleasant for the child, we propose to refrain from this if the clinical score is positive. Patients with a negative clinical score are suitable candidates for US to establish and secure diagnosis.© 2013 The Authors. BJU International © 2013 BJU International.

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