eMedicine Specialties > Urology > Common Problems of the Testicle

Testicular Torsion: Treatment

Author: Eugene Minevich, MD, Assistant Professor, Department of Surgery, Division of Pediatric Urology, University of Cincinnati
Coauthor(s): Leslie Tackett, MD, Fellow, Departments of Surgery and Pediatrics, Division of Pediatric Urology, Children's Hospital Medical Center at Cincinnati
Contributor Information and Disclosures

Updated: Feb 9, 2007

Treatment

Medical Therapy

Manual detorsion of the torsed testis may be attempted but is usually difficult because of acute pain during manipulation. This nonoperative detorsion is not a substitute for surgical exploration. If successful (ie, confirmed by color Doppler sonogram in a patient with complete resolution of symptoms), perform definitive surgical fixation of the testes before the patient leaves the hospital as an urgent—rather than emergent—procedure.

Surgical Therapy

Treatment of testicular torsion varies according to patient age.

  • Treat patients who are born with testicular torsion by performing early elective exploration and contralateral orchidopexy (anchoring) because bilateral (synchronous or asynchronous) neonatal testicular torsion is described.
  • The potential for salvage of such a testis is nil, making the risk of immediate surgery before complete stabilization of the newborn unwarranted.
  • In distinct contrast, a newborn with a normal testis at birth who subsequently undergoes torsion requires immediate exploration.
  • Perform the operation through the midline scrotal raphe.
  • Enter the ipsilateral scrotal compartment; then, deliver and untwist the testis.
  • Evaluate the testis for viability.
  • Remove the necrotic testis to avoid prolonged, debilitating pain and tenderness. 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. Perform both exploration and anchoring of the contralateral testis through the same incision.

Intraoperative Details

Signs of a viable testis after detorsion (see Image 3) include a return of color, return of Doppler flow, and arterial bleeding after incision of tunica albuginea.

Postoperative Details

  • Testicular prosthesis placement
    • Patients requiring an orchiectomy because of a nonviable testis may benefit from the placement of a testicular prosthesis.
    • Delay this placement, usually for 6 months, until healing is complete and inflammatory changes resolve.
    • Perform the prosthetic placement through an inguinal incision.

Complications

Torsion of the spermatic cord continues to be one of the few emergencies in urologic practice. Delay of more than 6-8 hours between onset of symptoms and the time of surgical (or manual) detorsion reduces the salvage rate to 55-85%. A correlation may exist between the duration of torsion and abnormal semen parameters, and some authorities suggest that retention of an injured testis can induce pathologic changes to the contralateral testis.

More on Testicular Torsion

Overview: Testicular Torsion
Workup: Testicular Torsion
Treatment: Testicular Torsion
Follow-up: Testicular Torsion
Multimedia: Testicular Torsion
References
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References

  1. Barada JH, Weingarten JL, Cromie WJ. Testicular salvage and age-related delay in the presentation of testicular torsion. J Urol. Sep 1989;142(3):746-8. [Medline].

  2. Brandt MT, Sheldon CA, Wacksman J, Matthews P. Prenatal testicular torsion: principles of management. J Urol. Mar 1992;147(3):670-2. [Medline].

  3. Johnston BI, Wiener JS. Intermittent testicular torsion. BJU Int. May 2005;95(7):933-4. [Medline].

  4. Lewis AG, Bukowski TP, Jarvis PD, et al. Evaluation of acute scrotum in the emergency department. J Pediatr Surg. Feb 1995;30(2):277-81; discussion 281-2. [Medline].

  5. Mor Y, Pinthus JH, Nadu A, et al. Testicular fixation following torsion of the spermatic cord--does it guarantee prevention of recurrent torsion events?. J Urol. Jan 2006;175(1):171-3; discussion 173-4.

  6. Rabinowitz R, Hulbert WC Jr. Acute scrotal swelling. Urol Clin North Am. Feb 1995;22(1):101-5. [Medline].

  7. Smith-Harrison LI, Koontz WW. Torsion of the Testis: Changing Concepts. AUA Updates. 1990;32.

  8. Sun J, Liu GH, Zhao HT, Shi CR. Long-term influence of prepubertal testicular torsion on spermatogenesis. Urol Int. 2006;77(3):275-8.

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Further Reading

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Keywords

testicular torsion, intravaginal testicular torsion, extravaginal testicular torsion, torsion of the spermatic cord, torsion of the testis, epididymitis, orchitis, epididymo-orchitis, pyuria, bacteriuria, leucocytosis, contralateral orchidopexy, orchiectomy, testicular necrosis, testicular atrophy, scrotal swelling, intermittent testicular torsion, acute scrotum, bell-clapper deformity

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Contributor Information and Disclosures

Author

Eugene Minevich, MD, Assistant Professor, Department of Surgery, Division of Pediatric Urology, University of Cincinnati
Eugene Minevich, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Surgeons, and American Urological Association
Disclosure: Nothing to disclose.

Coauthor(s)

Leslie Tackett, MD, Fellow, Departments of Surgery and Pediatrics, Division of Pediatric Urology, Children's Hospital Medical Center at Cincinnati
Leslie Tackett, MD is a member of the following medical societies: American Urological Association
Disclosure: Nothing to disclose.

Medical Editor

Raymond Rackley, MD, Professor of Surgery, Cleveland Clinic Lerner College of Medicine at CWRU; Co-Section Head, Section of Voiding Dysfunction and Female Urology, Glickman Urological Institute, Cleveland Clinic Foundation
Raymond Rackley, MD is a member of the following medical societies: American Urological Association
Disclosure: Pfizer, Novartis, Proctor & Gamble, Allergan Honoraria None; Pfizer, Novartis, Proctor & Gamble, Allergan Consulting fee Other

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Shlomo Raz, MD, Professor, Department of Surgery, Division of Urology, University of California at Los Angeles School of Medicine
Shlomo Raz, MD is a member of the following medical societies: American College of Surgeons, American Medical Association, American Urological Association, and California Medical Association
Disclosure: Nothing to disclose.

CME Editor

J Stuart Wolf, Jr, MD, FACS, David A Bloom Professor of Urology, Director, Division of Minimally Invasive Urology, Department of Urology, University of Michigan Medical Center
J Stuart Wolf, Jr, MD, FACS is a member of the following medical societies: American College of Surgeons, American Medical Association, American Urological Association, Catholic Medical Association, Endourological Society, Society for Urology and Engineering, Society of Laparoendoscopic Surgeons, and Society of University Urologists
Disclosure: Terumo Corporation Consulting fee Consulting; Omeros Corporation Consulting fee Consulting

Chief Editor

William J Cromie, MD, MBA, President and Chief Executive Officer, Health Care, Capital District Physicians' Health Plan
William J Cromie, MD, MBA is a member of the following medical societies: American Academy of Pediatrics, American College of Surgeons, American Medical Association, American Urological Association, Medical Society of the State of New York, Société Internationale d'Urologie (International Society of Urology), Society for Pediatric Urology, Society of University Urologists, and Society of Uroradiology
Disclosure: Nothing to disclose.

 
 
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