Utility of Clinical Signs in the Diagnosis of Testicular Torsion in Pediatric Age: Optimization of Timing in a Time-Sensitive Pathology

<b>Background/Objectives</b>: Acute scrotal pain in children and adolescents requires prompt evaluation to differentiate testicular torsion from other scrotal pathologies. Testicular torsion, a surgical emergency, can lead to irreversible testicular damage if not managed rapidly. This study aims to assess the clinical signs, diagnostic tools, and outcomes related to testicular torsion in patients presenting with acute scrotal pain. <b>Methods</b>: A retrospective analysis was conducted on 111 patients diagnosed with acute scrotal conditions. Clinical signs, presentation times, ultrasound findings, and treatment outcomes (surgical intervention, orchiectomy, or medical management) were evaluated. The statistical analysis was performed with a <i>p</i>-value < 0.05 being considered significant. Correlations between clinical signs, diagnostic imaging, and treatment modalities were assessed. <b>Results</b>: The most prevalent clinical signs were scrotal swelling (92.2%), pain on palpation (93.5%), and scrotal hyperemia (84.4%). Testicular torsion was strongly associated with the absence of the cremasteric reflex (<i>p</i> < 0.0001) and testicular retraction (<i>p</i> < 0.0001). Ultrasound findings, including absent blood flow and testicular heterogeneity, were highly predictive of surgical intervention (<i>p</i> < 0.01). Patients presenting within 8 h of symptom onset had higher success rates of detorsion and testicular preservation. <b>Conclusions</b>: Timely and accurate clinical assessment, including the identification of key signs such as the absence of the cremasteric reflex and testicular retraction, is critical for differentiating testicular torsion from other conditions. Ultrasound findings are pivotal in guiding treatment decisions in cases of clinical uncertainty. Early intervention significantly improves testicular viability and outcomes, underscoring the importance of rapid diagnosis and management.