From the Guidelines
Testicular torsion is a medical emergency that requires immediate surgical intervention, and the primary treatment is manual detorsion followed by surgical correction called orchiopexy, as delays beyond 6 hours significantly increase the risk of testicular loss 1.
Importance of Prompt Treatment
The treatment of testicular torsion involves manual detorsion to temporarily restore blood flow, but this is not a definitive treatment. Surgery involves making an incision in the scrotum, untwisting the spermatic cord, and fixing both testicles to the scrotal wall to prevent recurrence.
Diagnostic Considerations
The diagnosis of testicular torsion can be made using ultrasound (US) as the established first-line imaging modality for acute scrotal disease, which can be used to diagnose most scrotal disorders when combined with clinical history and physical examination 1.
- US findings in testicular torsion include an enlarged heterogeneous testis that may be hypoechoic, ipsilateral hydrocele, skin thickening, and no color Doppler flow in the testis or spermatic cord.
- A twisted spermatic cord is the most specific US sign of torsion, and the “whirlpool sign” refers to a spiral twist of the spermatic cord that may be associated with a heterogeneously echogenic pseudomass below the point of torsion.
Post-Operative Care
Post-operative care includes rest for 1-2 days, scrotal support, ice packs to reduce swelling, and pain medication like ibuprofen or acetaminophen. Antibiotics may be prescribed to prevent infection. Complete recovery usually takes 2-4 weeks, during which strenuous activity should be avoided.
Key Points to Consider
- Prompt recognition and surgical exploration within 6 to 8 hours after symptom onset is essential to prevent testicular loss 1.
- The testicular salvage rate depends on the degree of torsion and the duration of ischemia.
- US is generally well tolerated and widely available, making it ideal for scrotal evaluation, and high-resolution grayscale and color Doppler US allow prompt and accurate differentiation of scrotal emergencies 1.
From the Research
Treatment for Testicular Torsion
- Testicular torsion is a surgical emergency that requires prompt recognition and treatment to salvage the testicle 2
- The treatment for testicular torsion typically involves surgical exploration, detorsion, and orchidopexy for a salvageable testis 3
- Manual detorsion can be an efficient and reliable procedure when applied together with elective orchiopexy as a part of the treatment 4, 5
- Immediate manual detorsion at diagnosis can lead to improved surgical outcomes in testicular torsion patients, with a higher probability of testicular salvage 6
Surgical Techniques
- There is limited evidence in favor of any one surgical technique for acute testicular torsion, and the method of orchidopexy can vary 3
- Different surgical techniques have been reported, including various incision and suture methods, with varying outcomes and complications 3
- The choice of surgical technique may depend on the individual patient and the surgeon's preference, and further studies are needed to determine the optimal approach 3
Timing of Treatment
- Delay in treatment can be associated with decreased fertility, or may necessitate orchiectomy, and there is typically a four- to eight-hour window before permanent ischemic damage occurs 2
- Interhospital transfer and surgical wait times can negatively impact testicular salvage, with each hour of transfer time and surgical wait time decreasing the probability of a favorable outcome 6
- Immediate detorsion and prompt surgical intervention are crucial to improve outcomes in testicular torsion patients 6