Best evidence topic report: in emergency settings, can an absent cremasteric reflex be used to aid diagnosis of testicular torsions?

A short systematic review was completed to answer the three-part question: in patients presenting with acute unilateral testicular pain, is an absent cremasteric reflex an accurate sign for diagnosis of testicular torsion (TT)? MEDLINE, Embase and Cochrane databases were searched on 05 January 2025 using the outlined search strategy. 67 unique papers were found and screened for relevance. 13 relevant papers were identified. Study information, participant group, relevant outcomes and study weaknesses were extracted from each paper and presented in a table. Results revealed up to 100% of patients with TT had an absent cremasteric reflex; however, due to small sample sizes, there was wide variation in sensitivities (21-100%) between the papers. Small sample sizes and the inclusion of retrospective studies were significant limitations within this paper. The clinical bottom line proposes that although an absent cremasteric reflex is common in TT, the presence of a cremasteric reflex cannot be used to rule out TT.