genitourinary disorders
Testicular Torsion
Treatment of Testicular Torsion
Manual detorsion Surgery: Urgently if detorsion is unsuccessful, otherwise electively Immediate manual detorsion without imaging can be attempted during the initial examination; its success is variable. Because testes usually rotate inward, for detorsion the testis is rotated in an outward direction (eg, for the left testis, detorsion is clockwise when viewed from the front—underneath the testis; a mnemonic is "Stand at the foot and open the book."). More than one rotation may be needed to resolve the torsion; pain relief guides the procedure. If detorsion fails, immediate surgery is indicated, because exploration within a few hours offers the only hope of testicular salvage. Testicular salvage drops rapidly from 80 to 100% at 6 to 8 hours to near zero at 12 hours. Fixation of the contralateral testis is also done to prevent torsion on that side. When manual detorsion is successful, bilateral testicular fixation is done electively. 