Treatment for Testicular Torsion
Immediate urological consultation and prompt surgical exploration with detorsion is the definitive treatment for testicular torsion, and must be performed within 6-8 hours of symptom onset to prevent permanent testicular loss. 1
Surgical Management
The primary treatment is emergency surgical exploration, detorsion, and bilateral orchidopexy. 1, 2
- Surgery must occur within 6-8 hours of symptom onset to maximize testicular salvage, with better outcomes when performed within 12 hours. 1
- The surgical procedure involves untwisting the spermatic cord and fixing both testes to prevent recurrence. 2, 3
- Bilateral orchidopexy is performed because the anatomic "bell-clapper" deformity that predisposes to torsion is typically present bilaterally. 3, 4
- Even if the affected testis appears non-viable, surgical exploration is still indicated to confirm the diagnosis and fix the contralateral testis. 1
Adjunctive Pre-Surgical Interventions
Ultrasound-assisted manual detorsion can be attempted while awaiting surgery or transfer, as it is non-invasive, quick, and can rapidly restore testicular blood flow. 5, 4
- Manual detorsion involves rotating the testis in an "open book" fashion (lateral to medial), typically requiring 180-720 degrees of rotation. 5
- This maneuver can relieve symptoms, maximize testicular salvage, and facilitate subsequent surgery, but does not replace the need for surgical exploration. 5
- Ultrasound guidance during manual detorsion allows real-time confirmation of successful restoration of blood flow. 5
Post-Operative Care
- Post-treatment management includes bed rest, scrotal elevation, and analgesics until inflammation subsides. 1
- Follow-up is necessary to monitor for complications including testicular atrophy (reported in 9.1-47.5% of cases) and potential fertility issues. 2
Critical Time-Sensitive Considerations
The 6-8 hour window is critical—permanent ischemic damage occurs after this timeframe, making this a true surgical emergency. 1, 6
- Testicular salvage rates decrease dramatically with delayed intervention beyond 6 hours. 1
- Do not delay surgical consultation for imaging if clinical suspicion is high, as outcomes are directly time-dependent. 4
- Even with negative or equivocal ultrasound findings, surgical exploration should proceed if clinical suspicion remains high, as false-negative Doppler evaluations can occur with partial torsion or spontaneous detorsion. 1