Guideline sources The following summarized guidelines for the evaluation and management of testicular torsion are prepared by our editorial team based on guidelines from the European Association of Urology (EAU 2022) and the American College of Radiology (ACR 2019). 1 2 Calculator Testicular Workup for Ischaemia Guidelines 1. Diagnostic investigations History and physical examination: Elicit history and perform physical examination for the diagnosis of testicular torsion. Base the clinical decision on physical examination. A Diagnostic imaging: As per EAU 2022 guidelines, obtain Doppler ultrasound for the evaluation of patients with acute scrotum without delaying the intervention. A Recognize that Doppler ultrasound is comparable https://web.pathway.md/diseases/recrlBpJ4EoP0llUy 1/2 6/24/23, 4:05 PM Testicular torsion Pathway to scintigraphy and dynamic contrast-enhanced subtraction MRI. B As per ACR 2019 guidelines, obtain Doppler ultrasound as the initial imaging in adult and pediatric patients with an acute onset of scrotal pain without trauma or antecedent mass. B 2. Medical management Conservative management: manage patients with torsion of testicular appendage conservatively. A 3. Surgical interventions Timing of surgery: recognize that testicular torsion is a pediatric urological emergency and requires immediate treatment. A Manage neonates with acute scrotum as surgical emergencies. B Show 3 more Technical considerations for surgery: perform orchidopexy of the contralateral testicle in neonates with testicular torsion. B References 1. Lisette A 't Hoen, Guy Bogaert, Christian Radmayr et al. EAU guidelines on Paediatric Urology. EAU. 2022 Mar. Open 2. Expert Panel on Urological Imaging:, Carolyn L Wang, Barun Aryal et al. ACR Appropriateness Criteria Acute Onset of Scrotal Pain-Without Trauma, Without Antecedent Mass. J Am Coll Radiol. 2019 May;16 5S S38 S43. Open 3. Jo o A Barbosa, Bruno Camargo Tiseo, Ghassan A Barayan et al. Development and initial validation of a scoring system to diagnose testicular torsion in children. J Urol. 2013 May;189 5 1859 64. Open https://web.pathway.md/diseases/recrlBpJ4EoP0llUy 2/2