From the Guidelines
The immediate treatment for suspected testicular torsion is emergency surgical exploration and detorsion (untwisting) of the affected testicle, ideally within 6 hours of symptom onset to maximize the chances of testicular salvage. This is a true urological emergency requiring immediate medical attention. 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 surgical intervention, pain management with analgesics may be provided, but this should not delay definitive treatment. Manual detorsion by a physician may be attempted in some cases to temporarily restore blood flow, but this does not eliminate the need for surgery. 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 preventatively. Prompt treatment is critical because testicular torsion cuts off blood supply to the testicle, and without restoration of blood flow, testicular necrosis can occur within 4-8 hours, potentially resulting in loss of the testicle and affecting fertility, as highlighted in the most recent guidelines 1.
Some key points to consider in the diagnosis of testicular torsion include:
- The use of ultrasound (US) as the first-line imaging modality for acute scrotal disease, which can help diagnose most scrotal disorders when combined with clinical history and physical examination 1.
- The importance of prompt recognition and surgical exploration within 6 to 8 hours after symptom onset to prevent testicular loss, as emphasized in recent updates 1.
- The role of clinical risk scoring systems, such as the Testicular Workup for Ischemia and Suspected Torsion Score, in evaluating patients with suspected testicular torsion, although these have not been widely adopted 1.
Overall, the priority in managing suspected testicular torsion is to minimize delay and ensure prompt surgical intervention to preserve testicular function and fertility.
From the Research
Immediate Treatment for Suspected Testicular Torsion
The immediate treatment for suspected testicular torsion involves prompt medical attention to prevent long-term damage. Key points to consider include:
- Testicular torsion is a surgical emergency that requires immediate attention 2, 3, 4.
- The condition involves the twisting of the spermatic cord, resulting in acute pain and ischemia 4.
- Symptoms may include a red, swollen scrotum, acutely painful testicle, nausea, and vomiting 4.
- Physical examination techniques, such as scrotal elevation, can help differentiate between epididymitis and testicular torsion, but emergent imaging with Doppler ultrasound is often necessary to confirm the diagnosis 4.
- Manual reduction of the torsion may be attempted, but many cases require immediate referral to a urologist for surgical exploration 4.
Surgical Intervention
Surgical intervention is crucial in the treatment of testicular torsion. Points to note:
- Accepted practice is surgical exploration, detorsion, and orchidopexy for a salvageable testis 5.
- The method of orchidopexy may vary, with different techniques differing in incision, type of suture, and points of fixation 5.
- Postoperative complications can occur, including scrotal abscess and stitch abscess 5.
- Contralateral testis fixation is often performed to prevent future torsion 5.
Diagnostic Tools
Diagnostic tools play a vital role in the evaluation of suspected testicular torsion. Consider:
- Color Doppler ultrasound is considered the investigation of choice, but it may not always be available in emergency situations 6.
- The Testicular Workup for Ischemia and Suspected Torsion (TWIST) score is a clinical scoring system that can aid in the diagnosis of testicular torsion, reducing the need for color Doppler in some cases 6.
- The TWIST score has a high predictive value and can help identify low-risk and high-risk patients 6.