Testicular torsion is one of the few true urologic emergencies It does not always present in the same way Any boy with abdominal pain must undergo a testicular examination, because testicular torsion may present solely with abdominal pain, without any scrotal complaints Testicular masses must be diagnosed promptly for best outcomes Background Primordial germ cells have their origin in the endoderm of the yolk sac By the fifth week of intrauterine life, they have reached the ventromedial portion of the urogenital ridge, the portion destined to form the testes A mesodermal cord, the gubernaculum, becomes attached to the bottom of the testis at the epididymis and runs to the bottom of the scrotum With rapid growth of the trunk, the testes lie adjacent to the internal ring by the third month of gestation The testes remain at this location until the seventh month when, preceded by a fold of peritoneum (the processus vaginalis), the testes move down the inguinal canal and reach their final scrotal position shortly before birth This fact accounts for the higher incidence of undescended testis in premature boys Testicular Torsion Goals of Treatment Torsion of the testis is one of the few true urologic emergencies; time is of the essence The goal in management of testicular torsion is prompt diagnosis (aided by high index of suspicion) and early consultation with a urologist for prompt surgical treatment Clinical Recognition Key symptoms that should raise suspicion for testicular torsion are: (1) acute onset, often waking a boy up from sleep, (2) presence of nausea/emesis, (3) severe pain not improved by any position, and (4) sudden enlargement and redness of the hemiscrotum in a newborn Important signs on physical examination include (1) an enlarged, swollen hemiscrotum, (2) significant tenderness, (3) loss of cremasteric reflex, and (4) horizontal lie of the affected testis Any boy with abdominal pain must undergo a testicular examination, because testicular torsion may present solely with abdominal pain, without any scrotal complaints