If a patient has a negative cremasteric reflex, what condition should be suspected?

A negative cremasteric reflex is an important clinical finding that raises suspicion for testicular torsion. The cremasteric reflex involves the contraction of the cremaster muscle in response to stroking the inner thigh, resulting in the elevation of the testicle on the same side. In cases of testicular torsion, the blood supply to the testis is compromised, leading to a lack of stimulation of the cremaster muscle; therefore, the reflex is absent.

Testicular torsion is a surgical emergency, and the absence of this reflex indicates a potential compromise of the testicular blood supply, necessitating immediate evaluation and intervention. If the twisted spermatic cord is not corrected promptly, it can result in permanent testicular damage or loss.

Hydrocele, inguinal hernia, and epididymitis do not typically result in a negative cremasteric reflex. In hydrocele and inguinal hernia, the reflex may still be present because these conditions do not affect the blood supply to the testis in the same way. Epididymitis may present with varying reflex responses, but it generally does not lead to a negative cremasteric reflex unless there is significant involvement of surrounding structures.

Thus, the finding of a negative cremaster