Treatment of Testicular Torsion

Treatment

The treatment of testicular torsion is surgery and thus as soon as the diagnosis is confirmed the patient must be referred to a urologist for prompt surgery. Time is of essence and viability of the testes is highly dependent on prompt detorsion.

Manual detorsion

Manual detorsion is sometimes used to treat testicular torsion. However, this must only be done by the surgeon. The patient usually requires some form of IV sedation and also injection of a local anesthetic in the scrotum near the spermatic cord. The physician will manipulate the testes and try to rotate the testes into its original position. This is easier said than done. Frequently there is more than 360 degree of torsion and it is impossible to know how many turns to make for detorsion. After every manual detorsion, return of blood flow must be documented by ultrasound. Even if the detorsion is successful, elective surgery must be done to permanently repair the defect so that torsion does not recur.

A number of times this manual detorsion attempt fail and frequently the situation worsens. Most urologists prefer to take the patient straight to the operating room instead of mucking around blindly with a serious condition. When successful, manual detorsion results in immediate relief of pain. Data from some series reveal a success rate of only 20% and in some cases there has been an 80% success rate (more based on luck than any technical skill).

The surgeon should never persist and be obsessive about manual detorsion. If it fails, the patient should be hurried to surgery. Only surgery can provide the definite treatment.

In addition, given the risks of a missed diagnosis, scrotal exploration may be needed if a definitive diagnosis cannot be made. If the testicle is not viable, it must be removed. In many cases, when torsion of the testes occurs on one side, it is very likely that the same anatomical defect occurs on the other side and thus, most urologists will also fix the other testes to prevent future torsion.

Postoperative surgery

In individuals who required complete removal of the testis because of non viability, a testicular prosthesis is available. This can be placed in the scrotum at around 3-6 months, once healing is complete.