From the Guidelines
The immediate treatment for suspected testicular torsion is emergency surgical exploration and detorsion, which should be performed as soon as possible, ideally within 6 hours of symptom onset, to maximize the chances of testicular salvage. This is a true urological emergency requiring immediate medical attention, and any delay in treatment can result in significant morbidity and potential loss of the testicle 1. The patient should be transported to the nearest emergency department without delay, and should not eat or drink anything in preparation for possible surgery.
While awaiting surgery, pain management with analgesics may be provided, but this should not delay definitive surgical treatment. Cold compresses may offer temporary relief but are not a substitute for surgery. Manual detorsion can be attempted by a medical professional in some cases while preparing for surgery, but this does not eliminate the need for surgical exploration. During surgery, the affected testicle is untwisted, assessed for viability, and if viable, fixed to the scrotal wall (orchiopexy) to prevent recurrence. The contralateral testicle is typically also fixed preventively.
Key points to consider in the diagnosis and treatment of testicular torsion include:
- The use of ultrasound (US) as the first-line imaging modality for acute scrotal disease, which can help diagnose testicular torsion and other scrotal disorders 1
- The importance of clinical history and physical examination in combination with US findings to diagnose testicular torsion
- The need for prompt treatment to prevent testicular necrosis and potential loss of the testicle, as the risk of necrosis increases significantly after 6-8 hours of ischemia 1
- The role of surgical exploration and detorsion in the treatment of testicular torsion, which should be performed as soon as possible to maximize the chances of testicular salvage.
From the Research
Immediate Treatment for Suspected Testicular Torsion
The immediate treatment for suspected testicular torsion involves prompt surgical exploration, detorsion, and orchidopexy for a salvageable testis 2. This is because testicular torsion is a surgical emergency that requires immediate attention to prevent complications such as testicular infarction, necrosis, and sub/infertility 3.
Key Considerations
- Prompt recognition and treatment are necessary for testicular salvage, and torsion must be excluded in all patients who present with acute scrotum 4.
- There is typically a four- to eight-hour window before permanent ischemic damage occurs, and delay in treatment may be associated with decreased fertility or may necessitate orchiectomy 4.
- The method of orchidopexy used to prevent further torsion varies, and there is limited evidence in favor of any one surgical technique 2.
Management Strategies
- Suspected testicular torsion is a surgical emergency that usually requires urgent scrotal exploration 5.
- Urology departments should draw up guidelines for management, and trainees should be encouraged to discuss the case pre-operatively with the consultant 5.
- Core surgical training should include a urology placement to ensure that trainees are adequately prepared to manage testicular torsion 5.
Special Considerations
- In cases where a testicular mass is present in the contralateral testis, it is possible to safely treat a suspected benign testicular mass with testis-sparing surgery if it presents synchronously with testicular torsion 6.
- The management of testicular torsion and a contralateral testicular mass presenting synchronously requires careful consideration and a multidisciplinary approach 6.