Operative management of testicular torsion: current practice within the UK and Ireland

Several methods have been described and are currently used for fixation of testes in the operative treatment of testicular torsion. Although recurrence of torsion is generally viewed as a technical failure, the factors contributing to this failure remain unclear. This survey was conducted to establish current practice amongst paediatric surgeons in the UK and Ireland, in relation to testicular fixation, in an attempt to reflect the level of concern over the potential for recurrence as expressed in choice of procedure. The questionnaire survey indicated that 85% of paediatric surgeons use suture fixation of the testis alone or in combination with additional steps, such as eversion of the tunica vaginalis or creation of a dartos pouch, and 15% use a sutureless technique. The great majority (95%) fix the contralateral testis routinely and 85% routinely excise the appendix testis. Of the respondents, 17% have operated on a torted testis that had been previously fixed. In the absence of data from comparative trials, the method used for fixation remains a matter of personal preference. It was not possible to identify the definitive risk factors for recurrence from this study, but the use of absorbable sutures accompanied recurrence in most instances.