How is surgical detorsion performed for testicular torsion?

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

Either a midline raphe incision or bilateral transverse scrotal incisions can be made. Enter the ipsilateral scrotal compartment, incise the tunica vaginalis, and then deliver the testicle for examination. The spermatic cord is then untwisted. Evaluate the testis for viability. If viability is in question, place the testicle in warm sponges and reevaluate after several minutes.

If the testis is necrotic, perform an orchiectomy to avoid prolonged, debilitating pain and tenderness. In addition, retention of a necrotic testis may exacerbate the potential for subfertility, presumably because of development of an autoimmune phenomenon.

To prevent subsequent torsion, fix viable gonads to the scrotal wall with 3-4 nonabsorbable sutures. A dartos pouch can be made, into which the testicle is placed. Contralateral orchiopexy is always performed when testicular torsion is confirmed intraoperatively, in order to prevent future torsion of that testicle.


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