Acute Testicular Torsion Management

Testicular torsion is a common cause of acute scrotal pain and requires timely diagnosis and treatment to prevent testicular loss. Several factors must be taken into consideration when determining the appropriate treatment algorithm for patients. The definitive treatment is surgical exploration with orchiectomy or orchiopexy of the affected testicle and contralateral orchiopexy. The use of manual detorsion depends on the ability to proceed with immediate surgical exploration and should not delay definitive treatment. Recent developments in the understanding of ischemia-reperfusion injury in testicular torsion have led to the potential for nonsurgical adjuvants in the treatment of testicular torsion, although none are currently being used in practice. The treatment of neonatal torsion remains controversial and practice patterns vary greatly. Medicolegal concerns also play a role in the treatment decisions in both neonatal and nonneonatal testicular torsion. This review contains 6 figures, 5 tables, and 54 references. Key Words: compartment syndrome, detorsion, infertility, ischemia-reperfusion injury, orchiopexy, surgical exploration, testicular prosthesis, testicular torsion