Old and new aspects of testicular torsion

Torsion of the spermatic cord is a common condition that requires emergent treatment. Diagnosis based on history and physical examination is rarely conclusive and, although a number of radiographic studies can be helpful, any clinically suspicious lesion should be treated immediately. Manual detorsion may be helpful, but operative exploration with bilateral orchiopexy is still essential. Prolonged torsion usually results in unilateral testicular atrophy and, in postpubertal animals, an autoimmune injury with consequent contralateral testicular damage is seen. This suggests that, in humans, necrotic and perhaps marginal testes should be removed. In addition, subfertility after unilateral torsion may be due to a preexisting abnormality in both testes. Nonetheless, the cornerstone of management remains rapid detorsion and bilateral fixation to prevent future torsion.