What is the technique to treat left testicular torsion?

From the Guidelines

The manual detorsion technique for left testicle torsion involves rotating the testicle outward (laterally) like opening a book, typically in a counterclockwise direction when viewed from below, as a temporary emergency measure to restore blood flow and alleviate pain, but immediate urological evaluation and surgical intervention are still necessary to prevent recurrence. To perform this procedure, first administer appropriate pain medication and apply gentle but firm pressure to grasp the affected testicle between your fingers. Then rotate the testicle outward (laterally) 180 degrees or until pain subsides. Success is indicated by immediate pain relief, improved blood flow, and a more normal testicular position. This technique works by unwinding the twisted spermatic cord, restoring blood flow to the testicle. Time is critical in testicular torsion cases, as tissue death can occur within 4-6 hours of complete torsion, making this a true urological emergency requiring prompt surgical management regardless of successful manual reduction, as supported by the most recent guidelines and studies, including the 2024 update on acute onset of scrotal pain without trauma or antecedent mass 1.

Key Considerations

• The technique should only be performed by a trained medical professional.
• Manual detorsion is not a definitive treatment and should be followed by immediate urological evaluation and likely surgical intervention (orchiopexy) to prevent recurrence.
• The use of ultrasound (US) can aid in the diagnosis of testicular torsion, with findings including an enlarged heterogeneous testis, ipsilateral hydrocele, skin thickening, and no color Doppler flow in the testis or spermatic cord 1.
• The "whirlpool sign" on US, referring to a spiral twist of the spermatic cord, is a specific sign of torsion, and the contralateral asymptomatic testicle should be used as an internal control 1.

Important Reminders

• Prompt recognition and surgical exploration within 6 to 8 hours after symptom onset is essential to prevent testicular loss, as emphasized in the 2024 update on acute onset of scrotal pain without trauma or antecedent mass 1.
• The sensitivity and specificity of color Doppler US for the detection of testicular torsion can be variable, and false-negative and false-positive results can occur, highlighting the need for correlation with clinical data and laboratory markers for infection 1.

From the Research

Technique for Treating Left Testicular Torsion

• The technique for treating left testicular torsion involves manual detorsion, which is a simple and immediately available procedure that can help maximize testis salvage 2, 3, 4.
• Manual detorsion is typically performed in a clockwise direction for left testicular torsion and counter-clockwise direction for right testicular torsion 4.
• The success of manual detorsion is defined as the relief of pain, normal physical examination, and confirmation by Doppler ultrasound performed immediately after the procedure 4.
• Real-time ultrasound-guided manual testicular detorsion can be used to confirm complete detorsion and ensure proper direction and completion of the procedure 3.
• In cases where manual detorsion is unsuccessful, emergency orchiopexy may be necessary to prevent testicular loss 2, 4.
• It is essential to note that atypical testicular torsion, such as lateral torsion, may require caution when performing manual detorsion 5.
• Manual detorsion and elective orchiopexy may be an alternative treatment for acute testicular torsion in children, with a success rate of 75% in one study 4.