Prehn’s sign: significance, positive, torsion of the testicle?

Definition: what is Prehn’s sign?

Prehn’s sign is a clinical sign which allows know the origin of pain felt in the testicles. It consists of lifting the testicle and asking the patient if the pain is relieved. This sign makes it possible to distinguish testicular torsion from inflammation of the epididymis (epididymitis). If raising the testicle soothes the pain, the sign is said positive and the doctor can orient his diagnosis towards a epididymitis. If this gesture does not relieve the pain, it is a testicular torsion.

What are the indications of Prehn’s sign?

“Prehn’s sign is indicated in case of acute testicular painto distinguish between testicular torsion, which represents an absolute surgical emergency, and inflammation of the epididymis (epididymitis). This sign is very unreliable. If in doubt, we prefer to operate to avoid necrosis of the testicle”, says Dr. Vincent Hupertan, urological surgeon in Paris.

Prehn’s sign must be performed by a urologist, the surgeon specializing in disorders of the genital and urinary systems of men and women. The technique consists placing his hand under the patient’s painful testicle and then lifting it.

What does a positive Prehn sign mean?

Prehn’s sign is said positive if lifting the testicle relieves pain. “This means that the pain is related to the gravitation which pulls and weighs on the testicle. It is therefore an inflammation of the epididymis (epididymitis)”, specifies the specialist.

What does a negative Prehn sign mean?

Prehn’s sign is said negative if lifting the testicle does not ease the pain : it is then a question oftesticular torsion, that is to say a twisting of the vessels of the testicle in the bursa, preventing it from receiving the blood supply necessary for its survival. This is an absolute surgical emergency to avoid testicular necrosis. She most often occurs before the age of 18.

Thanks to Dr. Vincent Hupertan, urological surgeon