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A Systematic Review on the Presentation and Management of Segmental Testicular Infarction
Lory Hage1,2, Alexandra Clerget1,3, Aziz Najjar1
1Department of Urology, Saint Joseph Hospital, Groupe Hospitalier Marie-Lannelongue Saint-Joseph, Paris, France.
Andrology
|July 30, 2026
Summary
Segmental testicular infarction (STI) is often misdiagnosed, leading to unnecessary surgeries. Improved awareness and Doppler ultrasound interpretation can aid in conservative management and testicular preservation for acute scrotal pain.
Area of Science:
- Urology
- Radiology
- Emergency Medicine
Background:
- Segmental testicular infarction (STI) is a rare cause of acute scrotal pain, frequently misdiagnosed as testicular torsion or malignancy.
- This misdiagnosis often results in unnecessary surgical interventions, highlighting a need for improved diagnostic strategies.
Purpose of the Study:
- To systematically review cases of STI to characterize its clinical presentation, imaging features, and management.
- To identify factors influencing diagnostic accuracy and the success of conservative management for STI.
Main Methods:
- A systematic review of PubMed and Embase databases was performed, adhering to PRISMA guidelines.
- Data from 75 studies involving 99 patients were analyzed, including demographic, clinical, imaging, and management details.
- Statistical analyses, including logistic regression and Classification and Regression Tree (CART), were used to identify predictors of diagnostic accuracy and management outcomes.
Main Results:
- Only 31.3% of STI cases were initially diagnosed correctly, with misdiagnoses including testicular tumors or torsion.
- Low or absent Doppler flow on ultrasound was associated with accurate diagnosis and conservative management.
- While 42.4% of patients received conservative management, 30.3% underwent total orchiectomy, with misdiagnosis strongly correlating with surgical intervention.
Conclusions:
- STI is frequently misdiagnosed due to overlapping clinical and imaging features with other testicular pathologies.
- Diagnostic uncertainty, not disease severity, is the primary driver for surgical intervention in suspected STI cases.
- Enhanced awareness, precise Doppler ultrasound interpretation, and structured diagnostic pathways can promote conservative management and testicular preservation.
