What is the role of surgery in the treatment of testicular torsion?

Updated: Aug 31, 2018
  • Author: Oreoluwa I Ogunyemi, MD; Chief Editor: Edward David Kim, MD, FACS  more...
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Answer

Immediate surgical exploration is indicated for patients with testicular torsion. For reliable salvage of the testicle, surgical repair must occur within 6 hours of symptom onset. [35, 41] If treatment is delayed, the patient may experience decreased fertility or may require orchiectomy. [42]

Surgical detorsion is the definitive treatment for testicular torsion. Manual detorsion of the torsed testis may be attempted but is usually difficult because of acute pain during manipulation. Nonoperative detorsion is not a substitute for surgical exploration, but it may improve rates of surgical salvage, [43] can protect testicular viability in cases of surgical delay, and also provides significant pain relief. Color Doppler ultrasonography can be used to determine the direction of testicular torsion and guide manual detorsion. [44]

If manual detorsion is successful (ie, confirmed by color Doppler sonogram in a patient with complete resolution of symptoms), the patient should undergo definitive surgical fixation of the testes before leaving the hospital, so that the operation can be performed as an urgent—rather than emergent—procedure.


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