From the Guidelines
Testicular torsion is a medical emergency that requires immediate surgical intervention, and the primary treatment is manual detorsion followed by surgical orchiopexy, as delays beyond 6 hours significantly increase the risk of testicular loss 1. The condition is characterized by sudden severe testicular pain, swelling, nausea, and vomiting, and if suspected, one should go to the emergency room immediately.
Key Considerations
- The surgical procedure involves untwisting the affected testicle, assessing its viability, and then securing both testicles to the scrotal wall to prevent recurrence.
- If the affected testicle is not viable (necrotic), it will be removed (orchiectomy).
- While awaiting surgery, pain management with analgesics like morphine or ketorolac may be provided.
Post-Operative Care
- Post-operative care includes rest, scrotal support, ice packs, and pain medication such as ibuprofen (600-800mg every 6-8 hours) or acetaminophen (650-1000mg every 6 hours) for 3-5 days.
- Antibiotics are not routinely needed unless there's evidence of infection.
Importance of Prompt Treatment
- Prompt treatment is crucial because testicular torsion cuts off blood supply to the testicle, and without restoration of blood flow within 4-6 hours, permanent damage or death of the testicle can occur, as highlighted in the 2024 update of the ACR Appropriateness Criteria 1.
From the Research
Treatment Options for Testicular Torsion
- Surgical intervention is the primary treatment for testicular torsion, aiming to reduce the torsion and restore blood flow to the affected testis 2, 3, 4, 5, 6
- The goal of surgery is to salvage the testis if possible, and orchiopexy is performed to prevent recurrence 2, 3, 4, 5, 6
Surgical Techniques
- Various surgical techniques are used for orchiopexy, including different incision methods and suture types 3
- The choice of surgical technique may not significantly impact the outcome, and more research is needed to determine the optimal approach 3
Outcomes and Complications
- Prompt surgical treatment is crucial to reduce the risk of testicular loss and improve outcomes 2, 4, 6
- Complications of testicular torsion and its treatment may include testicular atrophy, infertility, and scrotal abscess or stitch abscess 3, 4, 6
Alternative Treatment Approaches
- Manual detorsion and elective orchiopexy may be considered as an alternative treatment for acute testicular torsion in children, with reported success rates and minimal complications 5